BCBS of IL changing requirements

I just found out today that I was denied because they changed the requirements for surgery.  Instead of the 3 months of visits (I actually have 24 months) they now require 6 months.  And the forms that they sent my doc's office for progress checks are no longer compliant.  THe kicker is that they won't agree to count any of my previous time.  I am filing my appeal but would like some pointers.  PLEASE HELP!!!!

The same thing just happened to me. It seems BCBS is changing all their requirements for WLS.  I was disappointed, but decided I didn't put this weight on overnight and waiting an additional 3 months is minimal in comparison.  This just gives me time to learn more, adjust my diet more, and connect with others on here who have gone through this journey already.

Are you sure that you can't use your previous visits?  I was told by my surgeon's insurance coordinator that my prior months count, I just have to do 3 additional months. 

Hang in there!

ok, so I have IBX Personal Choice which is I think Blue Cross but it says Independence Blue Cross.. On March 31, they mailed me a letter that said that the notice of medical determination for my May 16 surgery has been approved.  NOW, I just got a letter today that was mailed on April 12th:
 "Based on our INITIAL review, additional medical information/documentation is needed to make a benefit determination.  The information/documentation needed includes the following:
        The clinical information necessary to review the request.

WTF DOES THAT MEAN!!!?!?!?!  it says it has requested this information from the healthcare providor but WHY WHY WHY are they all of a sudden sending me this letter??  Should I be freaking like I am?!?!?!  I just now opened my mail after settling the baby and doing some dishes and cleaning and its 12am and i am like freaking cause i can't call anyone at midnight to see what all of this is about...

I am in the EXACT same boat.  I sent in all my pre-determination paperwork on March 11th, withh all the necessary tests and the 3 months of dieting.  BCBS then changed their requirements on March 15th (so AFTER I sent in everything).  I got a notice on March 20th that I was denied because I didn't meet the 6 month diet requirement.  So I'm appealing.  But here's the kicker - BCBS gets 60 days to review your appeal and make a decision.  So even if I won my appeal I will have ended up completing the additional 3 months of dieting.  It all seems VERY shady to me. 

But I can't complain too much - it's only another 3 months.  I'll be sleeved in June/july.

Yer in CALI?  yer BCBS CA?  Cali PPO peeps DON'T HAVE TO DO A MEDICALLY SUPERVISED DIET!!  I have Cali BCBS..yeah I got denied at pre-authorization VSG investigational ...IT WAS back then!, called in my appeal...won on appeal 20 days later. NEVER did no medically supervised diet..even tho I live in NM my insurance is with BCBS Cali. Its a CALI thing...no m.s. diet.

CA Dept of Managed Health Care says so! They've got more ammo n cases to back ya up...that proves that medically supervised diets are a waste of time and money!

Since virtually everyone gets denied at pre-authorization for some ridulous reason or other...hopin you back off, get discouraged, don't appeal it....maybe this b.s. their throwin ya cuz they ain't got nothin else to deny ya!

Yeah I'd appeal! 

And YOUR policy states that BCBS have 60 days to review an appeal? 
Ive never heard of this. was always 30 days review on appeal.
I think ya need to look up yer policy...have an ONLINE LINK? It'll tell ya everything from criteria (all NIH but they won't tell ya that!)....to appeal process.

GO GET EM TIGER!!   such bull huh!!  Acckkkk  this hoop jumpin they make us do is sooo stressful once we've decided VSG...desperately impatient to change our lives....get on with it...they throw another wrench in....

Yeah appeal it... did your surgeons office submit yer 24 months of m.s diet?  if not send it in with yer appeal. If yer surgeon's office already had it...it went to ins. already...they got all the information they need...ALREADY...so no need to resubmit anything else! Just appeal...get it on the books!

To be denied for whatever b.s. reason at pre-authorization is to be expected. When it happened to me back in the day...I never expected it...it hit me hard! I appealed by phone...and approved 20 days later
VSG was investigational then....ITS OFFICIAL now CPT CODE 43775 ...but that don't stop them insurance cos from tryin to trip ya up!...Your pre-authorization is reviewed by low-level MDs at best.
Appeals are reviewed by board certified bariatric surgeons.

Maybe post with Insurance Forum
as well as your States Forum

BUT KNOW YOUR POLICY!! Get an online link! If I remember...yer medically supervised diet records are valid if done within 2 years....yer policy should have the details.

Much luck to ya!  n don't let the turkeys ummm...ins co's ;-) get ya down!

My surgeon submitted all 200+ pages.  Then I went through them page by page with theNurse that reviews them. 

I have BCBS of ILL not BCBS of CA.  So Carmelita, are you sure that in the state of California that I don;t have to do ANY supervised diet, even if my medical insurance plan says that I do have to do the diet?  If that's true, can you please tell me where I can get some supporting documentation for my appeal?

Thanks!
Kristen

Crap!  Nope you have BCBS IL.. you gotta abide by THEIR policy...even IF you live in Cali!

Bummer.