insurance help

Hi has anyone had problems getting approved with bcbsil/ ATT. They just denied my claim, I called them to find out why but could not get a anwer. My BMI is 39.9 and I have had a supervised diet. I have high blook pressure and joint pain, also I was diebetic when I was pregnant. Doctor thinks I will become diebetic, my sister and father both became diebetic. My Doctor is Dr. Gusky. I do have coverage.

Hi Maria, I also had a problem with bcbs of il ATT, and you are right no help when I called. What did your letter say???? I had the ins. coordinator set up a Peer to Peer consult-with my doctor and their doctor. That took about 1 week to get together, and the decision was over turned, right away. I won't find out what their conversation was until 3/7-next doctor appt.. But it worked-because I have a surgery date of 3/19. Your doctor will have to plead your case. Good Luck. Mina

The letter said, that I did not have diet history documentation, and I do. That I have not met the requirement. I am going to call the Kane center today. Thanks for the info on the consult that will help. I don't wan't to get bigger then I already am. I am only 5 feet tall.

Mina, Thank You for your help, called my doctors office and they called my insurance. Who is going to take one more look at the information they have infront of them. hopefull that this will help, I will need to call Diane at Dr Gusky's office next week tuesday. Thank's again. Maria

Hi Maria. I had BC/BS PPO of Illinois and got denied. I didn't have the one year documented physician supervised diet and even though my BMI was over 60, I still didn't get approved. I had Dr. Guske for my surgery. He is the best! I can't really advise you on this one. I wonder if your BMI isn't high enough? But you would think with the hypertension that would be in your favor. Just because you had gestational diabetes, I don't think that would suffice as a co-morbid condition, because if you're not pregnant, you don't have it anymore. Whether your doc thinks you will become diabetic, I don't know if that will help. I hope you get the denial reversed. Sometimes, it takes a little more time. For me, I just didn't want to wait anymore. I was afraid of getting a co-morbid condition in addition to gaining more weight. Good luck, Lucy

Maria --OH member Brenda Rideout-she works for BCBS IL, contact her...