managed weight loss (insurance)

bigbaby · 01-18-2007, 10:22 PM

:help: :help: My insurance BCBC-TRS requires that I do 6 months of managed weight care under a doctor. As of last month I have lost 11lbs and my BMI is 40. When the doctor wasn't around the nurse whispered not to loose a lot of weight because the insurance won't pay if the BMI is under 40 without a co-morbidity. (and I don't have any) Is this true????:cry Should I do the minimal and show only a little weight loss or should I really try? When I left, I went straight to McDonalds:hungry:

anonemouse · 01-18-2007, 10:39 PM

I don't have BCBS, I have First Health, but I can tell you what my insurance required. My managed weight care rule was this: Documentation that patient has failed to lose weight (approximately 10% from baseline) or has regained weight blah blah blah. It also requires a comorbidity if your BMI is under 40. Depending on your insurance (I looked at all the BCBS programs that were in the packet of insurance requirements that my surgeon gave out, but didn't see yours.), they most likely won't pay for surgery if you get below 40 and stay there, especially since you don't have a comorbidity. The majority of the BCBS programs that were in my packet required a comorbidity if you had a BMI under 40.

StephC · 01-19-2007, 06:25 AM

I was at BMI of 40 when I began the 6 month study, and I immediately said to the doctor - wait a minute - what if I lose 10 pounds and it puts me below the required 40? He said they go by your highest weight. The most important thing about those 6 months is to make EVERY appointment, if you miss one you have to start from the beginning. The ins.co wants to see that you are dedicated to the process - along with all the other studies, sleep,pysch, heart...the whole bit. I never missed an appointment and actually went UP 7 lbs during those 6 months! (actually I was up and down several times during the 6 months - no different then the past 6 years!)

TracyinKS · 01-19-2007, 11:52 AM

I too have heard the horror stories of people missing an appointment and then having to restart the entire program...........

DON'T MISS!

Wheetsin · 01-19-2007, 11:54 AM

A friend of mine gained weight (intentionally) during her supervised diet and was denied because, in different speak, they did not believe she showed the potential to be successful with weightloss efforts.

bigbaby · 01-20-2007, 12:07 AM

Thanks for answering.....I think that I'll try to sightly go up and down....eat what I want all week and then 2 wees prior to my appointment--try and diet.....