Hello Joset, why haven't you been given a diet plan? Did you have your surgery in the UK? Every surgeon has a different diet, and no two people are on the same one. Weird I know. Contact your team if you can
Mine was two weeks clear liquids
Two weeks on soups, milk shakes and broths all with out lumps
two weeks on pureed foods { I couldn't stomach this step }
two weeks on soft foods like Protein yogurt, stewed mince and veg, soft scrambled eggs. Pate on hard crackers
Then onto any food I fancied. If you struggle on any step or with any foods go back a step for a few days. Eggs, salmon and chicken are hard for beginners.
Sorry I missed your original post, hope you are still on here.
Blue Cross Blue Shield Federal Employee Plan Denied My Gastric Sleeve Surgery
Question Below Submitted By:
In your section about Gastric Sleeve Surgery, it is mentioned that only two insurance companies have been known to cover it for folks in the past, one of which was the Blue Cross and Blue Shield Federal Employee Plan (FEP).
I was wondering if there is some more specific information on how this came to be known…as on many websites I was hearing stories that Federal BCBS covers the sleeve, but when I call them, they say they don’t.
I sent this question directly to you (Bariatric Surgery Source), and you kindly responded to let me know that you made this determination by reviewing/considering the following resources:
1)
CareFirst BCBS’s web site (BCBS plan in the Mid-Atlantic) – see table on page 3
2) Obesity Help patient forum
After further pursuing the matter with Federal BCBS, they have decided not to cover the sleeve for me. At one point in our many calls, one of the benefits people said that BCBSFed was going to be reviewing its policy on whether or not to cover the sleeve in April and should have a decision in May.
Since then we cannot get anyone to confirm this or repeat it. As much as I would prefer to have the gastric sleeve procedure, I have decided to move forward with gastric bypass surgery rather than wait until it is or is not approved.
I have submitted the bypass paperwork and do believe that it will be approved by Federal Blue Cross Blue Shield even without comorbidities.
Have a great day!
Heather
Submitted 4/5/2010
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Requirements for Pre-Approval of Weight Loss Surgery with Blue Cross
Your Anthem Blue Cross insurance policy covers weight loss surgery unless it states specifically that it excludes it. In order to be pre-approved for the procedure you must meet the following requirements:
- You need must be between the ages of 18 and 60 years old
- Exceptions to the age requirement can be made for patients under 18 years old if a letter is provided to the carrier by the physician stating that there is a dramatic risk for the patient’s health if surgery is withheld. Additionally, the letter should contain information regarding the physician’s evaluation of the patient’s mental health and have determined that the patient is prepared for such a surgery
- You need to be at a documented BMI level of over 40, or
- You need to be at a documented BMI level of over 35 and suffer from a minimum of one comorbid condition such as:
- Hypertension,
- Obstructive sleep apnea,
- Impaired glucose tolerance,
- Type 2 diabetes,
- Coronary artery disease.
- Written evidence must show that other
weight loss programs have failed to help the patient reduce or control their weight. These other programs must have been utilized for a minimum of twelve months consecutively to be considered. Some of these programs should have been prescribed by a physician other than the weight loss surgeon and may include:
- Weight Watchers
- Jenny Craig
- Top weight loss diet plans
- Any medically supervised weight loss programs.
What Weight Loss Procedures Does Blue Cross Cover?
The weight loss procedures that Blue Cross covers include.
- Lap Adjustable Gastric Bands
- Vertical Banded Gastroplasty
- Duodenal Switch
- Biliopancreatic Bypass
- Gastric Sleeve Procedure
- Gastric Bypass
Procedures Blue Cross Does Not Cover
While Blue Cross does cover most of the weight loss procedures there are a few that they do not. These include:
- Open and Laparoscopic Sleeve Gastrectomy
- Open Adjustable Gastric Banding
- Laparoscopic and open vertical banded Gastrectomy
Other Considerations
While you go into the weight loss surgery with high hopes and expectations that it will be a success, there is always a possibility that it will not be as successful as you had hoped. If this is the case and you find a second surgery or procedure is needed, you might find that Blue Cross Blue Shield does provide coverage for a second surgery as long as you followed post-operative instructions and made lifestyle changes for success as well as turned to the bariatric surgeon and other sources for additional help. Blue Cross Blue Shield does cover a revision surgery if it is needed. They do require that certain documentation is provided by the physician including:
- Reasons for failure of the surgery
- Date and type of procedure
- Evidence of patient’s compliance with all post-operative instructions including diet and exercise regimens
Blue Cross Blue Shield does not require that you seek surgery with an in-network surgeon. They do recommend that you utilize their in-network surgeons, however, in order to take advantage of their Center of Excellence. You can obtain a list of these professionals from your Blue Cross Blue Shield agent if you would like to consider these individuals for your surgery. Make sure that the individual that you do choose to work with is able to submit directly to Blue Cross Blue Shield for coverage of your procedure.
Related Resources
- How to Appeal Insurance Denial for Weight Loss Surgery
- What Bariatric Surgeries Are Covered By Insurance?