Question:
has anyone had the word "considered" for mo surgery??

i couldnt stand the suspense any longer so i contacted BC/BS of Ill. and asked if i was covered. they gave me a policy# and told me the web addy. Found out that i needed to have proof of mo for past 5 years and also 12 months supervised diet to be "Considered" for the surgery.i think that i can prove the 12 month but as for 5 years it could be a problem. ive had my pschy eval, cardio reports, sleep test (pos. for sleep apnea).i am 8 lbs short of having a BMI of 40. Any answers to my question would be greatly appreciated    — lisaindp (posted on June 21, 2006)

June 22, 2006
For the 5 year part, if you have went to your pcp every year, whether for checkups ormedical problems and have been morbidly obese for that time, that should suffice the 5 yr requirement. However, most want the supervised diet to be monitored by your pcp or possibly nutritionist, with weigh-in every month, with info to show what behavioral modifications were made, exercise suggested. This is an example: Jan-240 lbs, gave low calorie diet to patient to follow, then journal that, what you ate. Feb-239lbs, counseled on drinking 64 oz of water a day, told to walk, starting with 15 min and work up to 1/2 hr. Mar-238lbs, told to eat more protein and work up 15 min a week to walk at least 1 mile. Make sure you journal this stuff, what you eat and what exercise you are able to do. Even if you lose 10-15 lbs in that year, you should still be able, but they make you jump thru the hoops, at least Cigna does. I changed insurances when it was sign up time and was approve in a month, no supervised diet needed, the surgery just needed to be medically necessary. I don't think I could have ever passed Cigna's criteria. Health Alliance and Health Link of IL both just require medical nessessity.
   — geneswife

June 22, 2006
I think "considered" as stated here means that it's not guaranteed that they will pay for the surgery. They take it under consideration.
   — peacefuldaizy