Weight loss

Hi All,
It's me - your bari-godmother. Some of you may have noticed that we
have deleted the thread regarding BCBS coverage. I want to give you
some facts straight from the horses (the horse being BCBS) mouth. I
also want to do a couple of other things. Thanks to Regina Sutton
for initially providing the info which, for the most part, is
accurate. However, I fear that the posts will start an unecessary
panic amongst patients and we don't want that so I'm going to give
you the facts that were given to me by BCBS and they'll be complete
so there won't have to be any fear where none is needed.
1. The new criteria is currently (and I quote) "up for discussion
and comments". It is not yet written in stone. However, we expect
that there will only be minor changes.
2. The info is correct that BCBS is going to start requiring
completion of a 6 month medically supervised diet. This can include
(and I quote) "Weight Watchers, Jenny Craig, LA Weightloss, etc". It
cannot include any self monitored diets like Atkins or South Beach.
3. They WILL cover gastric bypass for people who have smoked within
the last three month. They will NOT COVER any pulmonary
complications resulting from surgical weight loss if the patient has
smoked in the last 3 months. Therefore this will require blood
testing for smokers. Our docs, Miles and Schmitt, already require
you to quit 6 weeks prior and now they will just extend that
requirement.
THE MAIN CHANGE that will affect waiting patients is the 6 months of
medically supervised diet attempts. A letter from you physician (and
I quote) "will not suffice". It must be medically supervised with
documentation of office visits, weigh ins and physician chart notes.
Or, as I said, Weight Watchers, Jenny Craig, LA Weightloss or another
organized program. Joining a gym and working with a personal trainer
will not suffice either.
We expected these changes and have been telling people for several
months at seminars that changes were coming. The primary concern
that I see for patients is that they will end up waiting a little
longer for surgery while they complete these new requirements. I
know it's frustrating but to be quite honest - some of these really
can be good for you. We KNOW it's good to quit smoking and weight
loss prior to surgery is also a good thing.
Please don't be angry at moderators for deleting the thread as it was
done on my order. I am simply trying to avert a panic where folks
start giving misinformation. Regina did not give misinformation but
you can see how the panic got started quickly.
Step back, take a breath and don't panic. It's only a hitch in the
giddyup - not a roadblock. A detour - not a dead end. Please don't
tie up your physician's phone lines with calls of panic. Your
physician cannot do anything about this.
Hugs,
Rona
Your Bari-Godmother