gfawcetti

Soooo.... I am trying not to be discouraged, however i am bummed. I got denied too by BCBSIL because the first month of my 6 month program with my PCP did not list my BMI. The first month I did the program was in April with a BMI of 40.8, then in May I was at a BMI of 39.8 so they considered the 39.8 the 'starting BMI' so I have to have the 2 co-morbidities. I am hopeful that when I have my PCP resend the note from April with the real starting BMI it will be approved since with a BMI of 40 I don't have to have any co-morbidities, but this is my worst fear... getting this far, getting this excited for nothing! I have heard from some ppl on this forum that they were able to talk to the person at the insurance who is making the decision... how do I do that?? I was told today that I couldn't talk to the nurse!! Bummer... Does anyone have any advice??? I really want this done in November... Thanks for listening, I was just hoping for better news Glenna

So I was one of those ppl who was about to submit to the insurance when BCBS of IL changed the requirements from 3 months to 6 months so I decided to just do a 6 month with my Dr. Well, yesterday was the final visit so it is gonna be resubmitted next week! I am so nervous that it won't go through... my BMI was just over 40 when I started so I should be fine, but I just want to know for sure!! Even though I can't have surgery till November because of work... Wish me luck!!! Glenna

Soooo.... I am trying not to be discouraged, however i am bummed. I got denied too by BCBSIL because the first month of my 6 month program with my PCP did not list my BMI. The first month I did the program was in April with a BMI of 40.8, then in May I was at a BMI of 39.8 so they considered the 39.8 the 'starting BMI' so I have to have the 2 co-morbidities. I am hopeful that when I have my PCP resend the note from April with the real starting BMI it will be approved since with a BMI of 40 I don't have to have any co-morbidities, but this is my worst fear... getting this far, getting this excited for nothing! I have heard from some ppl on this forum that they were able to talk to the person at the insurance who is making the decision... how do I do that?? I was told today that I couldn't talk to the nurse!! Bummer... Does anyone have any advice??? I really want this done in November... Thanks for listening, I was just hoping for better news Glenna

Quick update... the surgeon called & the Dr's office missed the August visit so they are resending it On a great side the notes look great with what she documented & she wrote a great letter stating that I was a great canidate for the surgery!! WooHoo!! Sending the ppk this week for sure... Glenna

So here is my question... in your exerience were your WW weigh in books enough for the 6 month diet program?? I have that I am going to send in with my appeal, and if it doesn't work I have to start the whole 6 month thing over again!! How frustrating is that!! I am REALLY hoping that it is enough because that is why I did it in the first place. Thanks for your help & nput... Glenna

Ok so I got the "official" denial letter today I knew it was coming because I had talked to them on the phone... I just called them back because the reason I was denied was the 6 months vs 3 months. I did find a weigh in book from 2009, but that isn't enough documentation because they need a medical professionals notes & signature!! I am bummed because i really want to get this done this spring... oh well. I guess waiting to re-submit till June isn't the end of the world, but it will cost me another $1000 in deductible (resets June 1, go figure) I am just so nervous that I won't get approved at all!! Anyone else in the same boat?? Glenna ps... I am going to write a letter to submit & see if my PCP will send one too, I figure I have until June I might as well send as much info as I can....

Well, I was officially denied this morning too ( I am bummed, but had tried to prepare myself for it... Anyway, I have done WW in the past 24 months, in addition to the last 3 months so i am going to dig up those old weigh in books to re-submit. I talked to the Ins person at the surgeons office and she recieved 4 denials this morning from BCBS of IL so lots of ppl are in this boat. She said that if I can find the weigh in books she will send in the appeal with new information so I am off to clean my closets LOL I will keep you posted!! Glenna

Hello Everyone.... I don't post often, however my info was faxed over to BCBS of Ill this afternoon... fingers crossed!! I am soooooo nervous I won't get approved. My bmi was 40.3 the first weigh in with WW (which is what it specifically says in the material they sent me) however I was only 39.4 when I started with the surgeon. So I am scared that loosing that 5 lbs is going to ruin the whole thing! Any advice?? Do I have reason to hope?! I am going to be a basketcase until I find out! Thanks for all your support even though I am not a big poster ) Glenna

Bummer... I am scared of the same thing!! Which BCBS do you have, if you don't mind me asking?? Glenna

Good luck.....I am excited to see what they say. I have BCBS of IL too & am having the same concerns. If you don't mind me asking what is your BMI?? Mine was 40.3 at my first weigh in at WW & that is what they are supposed to be using for approval, right?? Cuz I have lost a couple pounds in the supervised diet so my current BMI is 38.6 so I hope I haven't messed something up!! I am just worried I have gotten my hopes up for nothing... ya know? Hope you hear soon!! Glenna