BCBS-PPO ILLINOIS

Hi All, I am new to OH, have read lots of info here.  Now I find a need for help from all of you.  I have been in a Program for 8 months at the Wellness Center in Chicago, looking to have Lap-Band surgery at Northwestern Hospital, I thought I was totally on track, 6 months on the supervised diet-tho I did yo-yo, all info has been faxed to BCBS, BMI=44, diabetic 15 yrs-insulin dependent, sleep apnea, high blood pressure, high chlestorol, and now I receive THE LETTER OF DENIAL,,,,,,it sez "after careful consideration Lap Band Surgery would not be eligible, under your health care plan because there is limited documentation of active participation in a comprehensive non surgical weight management program."--------OK SO NOW WHAT, has anyone gotten one of these, what are they looking for, I know I need to appal, but am confused as to what they need. ANY INFORMATION, WOULD BE GREATLY APPRECIATED.,,THANKS TO ALL.. WAITING TO JOIN THE "LOSER'S' AND THEIR JOURNEY THX AGAIN, MINA

Hi Mina!  I am also with Dr. Nagle and go to the Wellness Institute at Northwestern. I have BC/BC of Michigan, and do not need prior approval, so do not have the same problem as you. But, I just wanted to say that I am so sorry you are having to go through this! I would say that it is the Wellness Institute's fault for not providing detailed notes on your monthly appointments. It seems like you were denied for "having limited documentation." Wouldn't that be the Wellness Institutes notes? I would complain to them and tell them that they need to amend their notes to better document what has been going on for the past 8 months! Good luck! I hope you get this sorted out soon! Danielle