BC/BS of Illinois

I am starting on the approval process for weight loss surgery with this insurer. Has anyone been successful in getting them to waive the 12 month diet requirement, or accept one that was several years ago? I'm having some problems I fear are going to be a whole lot worse if I have to wait that much longer.

BC/BS HMO? PPO? I think it makes a difference. I was approved quickly without having 12 consecutive month of a diet. I wrote my own letter of medical necessity, hand my PCP go over it, his admin. staff rewrite it on his letterhead and then submit it to the insurance. The letter documented EVERYTHING. Every possible condition I had that was either a true comorbidity or an health issue compounded by me being morbidly obese. I didn't leave anything out. My PCP created a histogram of my BMI for the past 12 years (at my request). The part in the letter which spoke directly to the medically supervised diet said something to the effect of: "My patient has been under my medical supervision for both diet and exercise 12 years and has seen my on a regular basis throughout this time." Hope this helps! KT

It is BC/BS PPO. Is that better or worse? One thing I do know is that there is a company rep at the plant where my husband works so he can hand things in directly and thereby avoid the "we never got it" claim.

I can only speak for my experience and my plan - BC/BS PPO of Illinois. Your particular plan may differ. But I will say this - there have been a number of people on this board crying about the 12 month requirement and I haven't seen one person get around it. With me they were very serious about the 12 months of doctor's supervised weight loss attempt (diet and exercise). I got approved on my first time through but I didn't submit until I had everything that they listed as required: 1. 12 month doctor supervised diet (my PCP chose weigh****chers or "WW") - with written monthly records of visits including weight and notes regarding discussion of diet and exercise; 2. WW records showing that I'd attended weekly for 12 month; 3. A letter from the health club (as well as some information about the club) stating that I'd attended at least 3 times a week over the last year; 4. Doctor's records showing that I'd been MO (40 BMI or higher) for 5 years; 5. Letters of medical necessity from both my PCP and surgeon; 6. Psychologist exam and recommendation; and, 7. Medical records demonstrating co-morbid conditions (sleep apnea under treatment - I have a CPAP - and high blood pressure). Even with all of that they didn't approve me until the Friday afternoon before my scheduled Monday surgery date!! I got the name of the person at BC/BS who was my company's designated contact and I called her every day for a month - after I knew my request for pre-determination was being reviewed. I was polite and nice, but persistent. My best advise to you is to get started with all of this now. See your doctor every month without fail and start recording your weight. Have your doctor put you on a diet and exercise plan. Then act on the plan and keep records that you are complying with it - trying your best. I did a year of WW and only lost about 15 pounds, but I could show that I'd done what was asked. It went by surprisingly quickly but I used the year to learn more about RNY and also kept seeing psychologists to get ready for this huge life changing event. Also, work with your surgeon's office. They know the most about what insurance plans are currently doing. I wish you all the best and an uneventful approval process! Hang in there! Illini

I was approved right away , no questions asked. Im on bc/bs hmo. Maybe because I am super morbidly obese and have severe sleep apnea. Not really sure why I got so lucky.

I tried almost a year ago. I have 10+ years of medical records, a great letter from my PCP and still they wont budge on he 12 month medicaly supervised diet. I am almost at the 12 month mark. This time around I am going to hire a lawyer from www.obesitylawyers.com They have a lot of experience with working with Weight loss surgery patients. They say that their success rate is around 90% To me it will be worth it to pay them to fight the ins company. I have BCBS IL ppo. Good Luck Mike