Who determines if you have to go on a pre-surgery supervised weight loss program?

JustinsMama · 02-12-2008, 05:30 PM

The surgeon or the insurance company? I called BCBSNC to see if I was covered. I was told under our plan it was if deemed medically neccessary (minus the $1,000 family deductible) (we have PPO-Blue Options 123). I then asked who determines if you have to go through a supervised diet before being approved. The BCBS rep told me that was up to the doctor, if he said I needed a 2 month or whatever prediet first, that BCBS would pay for it if the doctor deemed it was neccessary.

It just seems on here that I read it that when people say they have to diet for 6-12 months first before approval that it is the insurance company making them jump through this hoop. Anyone have any input?

Thanks in advance!

**Wheetsin** · 02-12-2008, 05:37 PM

Insurance requirements. Some sugeons may require patients to lose X lbs or X% of weight before they will do the procedure, but medically supervised diets are in the realm of the insurance companies.

Most of the time, anyway. I would imagine there could be an exception out there somewhere.

OH Juli · 02-12-2008, 06:16 PM

It was my insurance who said I needed 6 months of dr. supervised dieting.

that.gurl03 · 02-12-2008, 06:44 PM

From what my doc said it's typically the insurance co. (Mine did) but.. at my doc's office the have people go through a 4-5 week "pre-op nutrition" program. Which the person in charge of that said I may be able to have waived since I went through 6 mos that my insurance required. So I guess my answer is it just depends on what your doc & insurace decide.

JustinsMama · 02-12-2008, 06:58 PM

Thanks for the responses!