BCBSIL 5YEAR HISTORY

Anyone have a idea what they are looking for in the 5 year history of morbid obesity. I have sent in all the information of my weight for 5 years. When I was on the phone with bcbsil today the girl said they are looking to see if I have documentation at leat one a month for 5 years, anyone else have any ideas. I am so upset I have sent them all that they have requested. And what they request is changing all the time.

They tried to pull the same crap with me!! I sent them my weights for the last 5 years and it was not once a month!!. My surgeon went to bat for me and did a peer to peer review and then i was approved. Maybe your surgeon will help

Are you saying that BCBS said you needed to be into the doc once a month for a total of 5 years or at least have documentation of having a doctor visit(s) in the 5 years showing a consistant 5 year history of being MO? Let me tell you what happened to my sister who has Aetna POS with her retiree plan from AT&T - she was denied because she was not 5 years being MO, she was only 2 years being MO. Her plan from Aetna (AT&T) required the 5 years documentation from her doctor's office medical charts of her being MO. Now, let me tell you the clincher - she now is employed full time with a company that has Aetna POS and that policy only requires a 2 year documentation of being MO, she has since had her surgery. So, you see there are different policies with any insurance company. I will tell you right now that you will need to have the documentation from a doctor's charts, not just you writing a letter saying you have tried this, this and that diet for the last 5 years. If it is written in the policy of 5 years there really isn't any way around it. My sis tried it but was flat denied when she made two appeals. I really hope that you can get a straight answer from BCBSIL soon and good luck. Chris

I have been trying to get approved since June of 06. Every time they ask for more information. On May 7 the denied me for not having 6 month diet with doctors notes sent to them. So I sent them in all 9months worth. On May 20 they send me a letter saying they needed 5 year history of MO. So I searched all the information starting in June, 02 through June, 03 with Conure Medical center and notes for a 12month diet on fentermine. In 04 was hospitalized so I sent them all that plus weight in's with my doctor. My 9 month diet was in 05 & 06 and then June of 06 started the progress of getting approved. Well the one thing I do have is I'm going to ask Dr Grusky if he will call and talk to them. I have not yet officially received a denial. I will keep fighting and if all fails I can change to United Health Care on January 1/08. ATT gives us a few choices on insurance Co. I also am going to check with his union because the policies do need to be fair.

I too had to have five years history and I'm not proud of this but I had been seeing the same doc since I was 20yrs old and had been on many supervised diets which did involve monhtly appointments so I was able to pass the test. I'm very fortunate. I had to pay someone to pull my files from a warehouse and go page by page looking for documentation on weight issues. I paid $400. to have someone copy the pages and it was so worth it. I wish you the best of luck. Christina

It took me 16 months and 3 appeals to get approved by BCBS of IL. I had to provide five yrs documetation of obesity, but it was never expected of me to see a DR. once amonth in that 5yrs. The documentation came from all of my DR's. Then I had to go on a 12 month medically supervised diet and that is where the monthly criteria came in. They also changed the hoops they wanted me to jump through with each denial/appeal. They went so far as to deny me because there was no medical need for the surgery. They said they never got any my medical records. I have a very long list of co-morbid factors that was submitted to them w/my first application that they conveniently lost. So my surgery center messengered the whole caboodle to them so they couldn't lie about that again. It took a lot of perserverance bit I finally got approved and hope to have my surgery this May. Good Luck!

I am so glad that you stuck to your guns and kept after BCBS. I also see that you have Dr Rantis as your surgeon, great choice. My husband had his WLS with him also. Chris

I also have BcbsIl, although I have PPO, they do ask for 5 years of being MO. They are looking for Dr charts with your weights on them, and they do want like for me from 2002 through 2007. I already had my PCP fax over the chart records to the surgeons office. I have finished all the visits except the 6 month diet plan I have 5 of the 6 months left to go. Then they can submit everything and hopefully I will get approved. They are real sticklers for you to get everything to them that they ask I do know that. I also know you can look up on thier website, and if you still have questions, you can call them, or your surgeons office.

Does the chart listing have to be for weightloss dr.visits only? I have a 5 year history within my medical chart listing my BMI being over 40 since 2002, but these were listed in my chart at various appointments that I had, like my physical, sick visits and things like that. I have only recently considered weightloss surgery. I have BCBS PPO for IL as well and I want to make sure that those documentations are considered as well. Any thoughts?

Any DR. visit in a five yr period where your weight was taken and recorded. I used visits to cardio, pulmonary and diabetes DR.s as well as my PCP for my 5 yr documentation. Good Luck!