Hey OH,
Like I said I would be blogging often because I need to keep notes for myself.  My memory is hazardous so this is a great way for me to document my journey.

Okay well today I called BCBS of IL because I figured they had plenty of time to receive the faxed copies of the months they were missing. My surgeons' office sent them to two different fax numbers on Monday 8/27.  I was told that they did receive it and the medical board reviewed and denied it again.  Again, the c/s rep didn't understand why.  I asked her just exactly what are they looking for?  Are they sugguesting that I do that stupid 6 month supervised diet again?  She said no, but they are looking for specific notes from the doctor visits.  Apparently my doctor didn't write weight goals, caloric intake, exercise goals and portion control.  I asked her why aren't these specific requirements included in their coded descripton for gastric bypass surgery.  Of course she couldn't tell me.  I would have had all of this taken care of before they submitted the first time.  

Tomorrow I am going to call Gary Viscio (lawyer on the insurance forum)  and ask for his advice before we turn in another submittal.  BCBS of IL said my doctor could write a supplemental letter with those added requirements but it had to include every month of the 6month diet. So I just want to get some insight before I ask my doctor to do this.  The BCBS of IL c/s rep said that she was going to send it back through to the review board because she couldn't figure out why it was denied again since it looked to her like all the requirements were there.  Go figure. We'll see how it goes tomorrow.

Blessings

This is really my first blog even though I have been reading and posting since Nov. '96. I haven't had to much to really talk about because I was just waiting for my 6 month supervised diet to be over.  My surgeon had my paperwork for about a month. He reviewed it and they submitted it for approval. From what I can gather it was denied very quickly.  I found out yesterday.  I wanted to know right away the reason why.  All the office could tell me was that the insurance company left a voicemail saying something was up with my 6 month supervised diet and the way it was coded. It was denied.  I really wasn't surprised.  It seems everything little thing is a fight. So I gave myself yesterday to feel sorry for myself and after I spoke to the surgeon's office I called the insurance company.  I left a message with the person who left the original voice mail.  Of course she did not call me back. 

This morning I called the customer service number at BCBS of IL.  The first person I spoke to immediately made me feel she wanted to help me.  She connected me to another person and said she would stay on the line just in case she was needed. (She could have just been nosy, I don't know) The lady she connected me to looked over my file and said that she would have to investigate it more but just by scanning my paperwork a note was left that I did not actively participate in the 6 month diet.  The funny thing is I tried to make sure all of my paperwork was straight because I know the insurance companies MO.  The woman took my number and said she would try to call me back by early this afternoon.  That was at 10:40am.  She called me back at 12:35pm and said that it looks as if two months were missing.  She asked me to have the doctor's office fax those two months with notes to her and she would submit to the medical review board.  I will call the doctor on Monday and ask them to do this.  My surgeon's office also said they would help me get whatever needed to be done but it would have to be on Monday.  I started the ball rolling myself today so now on Monday all i have to do is get them to refax the months that are missing. 

I will post regularly now that the journey has really begun.  It will also help to document what I am doing because my memory leaves much to be desired.  Pleas Pray for me OH that I will be on the losing side soon.