Question:
Does BCBS PPO of IL REQUIRE medically supervised diet?

Has anyone been turned down by BCBS PPO of IL (or any BCBS PPO) specifically because they were never on medically supervised diets? I meet their other criteria but did not have insurance for a few years and only went to the doctor for emergencies. Any info would be greatly appreciated!!    — [Anonymous] (posted on February 5, 2002)

February 5, 2002
Hello! I previously had BC/BS of Illinois that was managed through Lake Forest Managed Healthcare and they DO require a multi year supervised diet. I think that it depends on who manages the insurance. I had a supervised diet about 5 years ago and they would not accept. So I only met 3 out of the 4 pre-requisites. I wound up changing to United Healthcare when my company swithced insurance. Good Luck!!
   — Ericka S.

February 5, 2002
I have Anthem BC/BS (Ohio/Indiana) and they required 12 months of consecutive DR. monitored diet history. However, since that is not part of the NIH criteria, (NIH only calls for failed dietary attempts) you can claim that their criteria does not meet prevailing generally accepted medical criteria. Do you have any co-morbidities? If so I would recommend hiring Walter Lindstrom to appeal their denial. I had been denied with a BMI of 62 and 6 of the 7 comorbidities that the NIH recommends this surgery if you have 1 and a BMI of 35 or higher. It cost $350 for an appeal letter from him, but I was approved 3 days after he sent them the letter. His web-site in obesitylaw.com. Any questions feel free to email me.
   — Dell H.