I got Approved in 2 months by BC/BS of IL

I did everything I read on this site to do, constant following up with the Insurance company and doctor's office. I created my own forms and had the doctor's sign off on it believing that too much information is better than no information at all. I created excell spread sheets and word documents, and ever piece of paper that was created by any doctor that I saw, I had my own copy. This allowed me to have it just in case someone said they didn't get a piece of information. BC/BS approved my request today, and faxed me a copy of the approval letter that was generated, so I would not have to wait for it to arrive by mail. I also took the time to fax my request into BC/BS so I wouldn't have to wait for the mail to take it there. Her is my timeline if anyone is interested March 23rd, initial consult (got referal for dietician, psych eval, and fitness eval) March 28 - met with dietician April 4 - had fitness eval April 18th - had psych eval Collected all paper documentation of my appointments from all the places I went and started a file. May 3rd - had follow-up consult May 11th - Dr. write letter to ins. company requesting authorization for surgery May 11th - I take all documentation and faxed it to Insurance company May 12th - insurance company faxes doctor's office a check list to make sure all info was met and to obtain his signature for medical necessity May 14th - Doctor fills it out and gives to his assitant at end of day May 15th - assistant faxes request to Insurance company, insurance approves and gives authorization to proceed, I requested letter to be faxed and they did at 1:15pm Now, if only the doctor's office will get off lunch and start answering phones, I can proceed with scheduling my appointment!!!!!!!!!!!!!!!!!!!!!! YEAHHHHHHHHHHH!

thats great!.. how did you go about getting the fitness eval?

Kelly C. At the time of my nutrician consult I was given a referral to a fitness evaluation. When I went to my appointment it consisted of the person I met with taking my height, weight, timing how long it took me to walk/run (if I could) 1 mile, body measurements (arms, breast, stomach, thigh, calf, and waist), going over exercises I can do to gain strength, giving me a strength test, and then documenting all of that. The end evaluation write-up said, I was strong enough to endure surgery, but because of my size and obesity level I am not where I should be concerning my strength level. Hoped this helped you

Good for you! Congratulations on your upcoming surgery. Hold on tight and enjoy the ride! Christina

That was pretty much how I handled getting approved...I have bcbs also .....With in 2 weeks I was approved when I decided to do it! Congrats and good luck! Karen

Great Job Tanya, I too have been working on getting approved. Did they require exact dates of former diets? What will be your starting BMI? Could you fax me examples? What surgery are having? Open or Lap? Too many ???s Thank you for your post, Babbs

Exact dates were not required, as part of my write up I documented all of the diet I had tried in the past - Weigh****chers - Master Cleanse - South Beach - Atkins Diet - Cabbage Soup - Phentermine pills & B-12 Shot - SlimFast - Paying $400 for a personal trainer and $450 for a gym membership - Tried the No carbs lifestyle During my 6 month physician supervised diet, I made sure that the doctor mentioned in his notes my response pertaining to my Weigh****chers diet. Part of BC/BC PPO states that your monthly physican notes should make mention of diet that's being followed. Here's an example of what one month of notes stated. General: Current Weight: 270.2 Blood Pressure: 141 / 68 Patient schedules appointment to begin a medically supervised weight loss program under my direction. BMI - 43.6 Patient reiterates she has a serious desire to loose weight for good. She has been overweight beginning as a child, and into her adult life. Has a strong desire to win the battle before she develops serious ailments that are weight related. Diet: Patient reports the following: DATE WEIGHT +/- COMMENTS July 27, 2006 274.0 + 4.2 Patient gained several pounds but feels this is a result of her menstrual cycle and the fact that she has begun a gym membership and working out with a trainer. Schedule follow up for 4-5 weeks. Have asked that she work with her gym to monitor her progress as well for evaluation at monthly doctor visits. August 9, 2006 In office weight in at 270.2 -4.2 1 month follow up appointment office weight in. Suggested patient start weigh****chers program to work on portion sizes. Reviews workout chart and progress being made. Reviewed with patient the need to watch caloric intake as well as increased exercise. Suggested caloric intake was to be at 1500 calories daily, increase water intake to at least 8 to 10 glass a day, and add more fruits and vegetable choices to meals daily. Handout given to describe portion sizes. Discussed ways to combat the issue of creating healthy meals ahead of time and the weigh****chers point system. Exercise: Patient encouraged continue moderate exercise program as can be tolerated. Walk or join an exercise program a minimum of 3x a week. She states personal training sessions are going well. She is keep all session appointments. Concerned that she is not seeing results. Behavior Modification: Patient encouraged to begin to journal all her activity for review at next appointment. Additional Notes: Next follow up to be scheduled for next month. Make sure that your physican signs the write up and a copy is kept in your personal medical records.

Congratulations on getting your approval.

Congrats on your approval. I also have BC/BS of Il but mine is PPO. Can I ask did you have to do the 6 month supervised diet. I read on their site that is standard requirement from them. I have done all the rest and am working on month number 2 of the 6 month diet. Thanks

My coverage is PPO also. I did have to do the 6 month evaluation, please see my notes above on what I asked my doctor to do for me. One of the suggestions I saw on this site was for every patient to bring to thier doctor's visit a copy of the insurance pre-requisites for the particular surgery you are looking to have. This allowed me to explain to my doctir why I needed all the information noted at each visit, since he supported me in my desire to loose weight he understood and complied. I did the 6 month evaluation stuff first, and then the other things last. From there it took me 2 months from scheduling to approval. So I guess It took a total of 8 months to meet all the requirements.