Heard back from BCBS

For all of you wonderful friends that sent up a prayer for me when I asked last month, Thank You. Unfortunately, BCBS of IL sent back this response: "Bariatric Surgery would not be eligible under your health care plan because No medical documentation of 12 consecutive months of successful nonsurgical weight management....." EXCUUUUSE ME!!!! If I was SUCCESSFUL, I would not need surgery!!! Never fear...the appeal letter is almost ready to be mailed. I'll keep you all posted on my progress, and thanks again for all of you support! Dawn

HA! Dawn - BCBS is a JOKE! read my profile if you want a good laugh. (start at OCT 28th for the insurance stuff) I started a new job on Monday and have to wait until May 1st for my new insurance to go into effect - but hopefully it will have better results for me! BCBS will NOT approve without the 12 month diet. I DID the diet and they STILL did not approve (gave me every reason in the book). I wish you all the luck in the world! patty

Dawn, don't give up the fight. Many of us have had BCBS and have had surgery after appeals. Get those Docs and Surgeon envolved with the insurance company. Barb s.

Dawn, I have BC/BS PPO of Illinois. They are serious about the 12 month requirement. I did the time: 1. 12 monthly doctor visits where I made sure she wrote down my weight and that we talked about weight, diet progress and exercise - it was all in my medical files, which I submitted to BC/BS; 2. joined a health club, kept records of attendance. Submitted a letter from the health club stating I attended at least 3 times a week throughout the year. Also submitted information about the club and its personnel (it's affiliated with a local hospital); 3. per my PCP's orders attended Weigh****chers (WW) weekly. Copied and attached to my BC/BS submission my WW attendance record and weigh ins; and, 4. had proof in my medical record (doctor recorded weight) of 5 years of being at a 40 BMI or higher and submitted that as well. I got approved the first time through after all of the above was submitted. No hassles. No appeals required. Find the BC/BS requirements online and follow them. Document all you do and submit it. Try to be patient (I know it's hard!) and use the 12 months to research and be in the right mind set. It will go by faster than you think. Good luck! Illini

Sorry this happened to you. I guess I was really lucky that I chose the HMO instead of the PPO through my employer!

I have to say I am grateful for my Dr who always documented my weight and Obesity as a diagnosis along with what ever else I was seeing her for, even if it was a cold, flu, asthma, high blood pressure etc. She was covering my butt before I even knew I wanted surgery, and before she brought it up to me and thru the time I was saying no way - that's not for ME! .. then when it came time that I decided to go for it my ducks were in a row. Also, I went thru barix, they were wizard's w/ my approval, they sent in everythingI possibly could have needed. I ended up not even needing my pcp's records. I was approved by bcbs ppo with in a few days of them recieving the info I would encourage anyone over weight to bring it up to their dr. at every visit. All the time I was p.o.'d at my dr for connecting all my health issues to my weight she WAS looking for my best interests, and funnily enough as I lost the weight all the health issues vanished. I hope you get this fixed and get your approval asap! I actually called the customer service center that approved my surgery when I knew the paper work was going in to find out what they wanted/ needed and if it was even covered under my specific plan ( they all differ, depending on what your employer wants/pays for, My booklet excluded all treatment for obesity such as diet, pills, etc, but didn't mention morbid obesity or surgery. very tricky if you ask me.) When I called I expected attitude due to the nature of my surgery, and when I told the woman her response was all positive! said that there was a guy in their office who had WLS and he had lost like 350 pounds, and now others in their office were having it, and was very supportive and wished me luck and congratulations. When I called back about precerting my Hospital stay, same thing, all congrats, and good luck etc. So hopefully you have a similar office that you have to deal with and will get the right resonse w/ your appeal.