stephany48463

hi guys start my diet the 8th....don't get sleeved til the 30th....have a feeling I will be here a lot needing your help!!

thanks guys, I already blew the money but maybe I will try to call him

cant seem to delete this thread...will figure it out...

Well its been a long stressful road but finally after three years and countless hours on the phone I have been APPROVED!! BCBS IL has denied me 3 times this week just because the werent looking at the info. They denied me for not having the 6 month diet documentation and for it being investigational. I called them and told then the documentation was there and that they had changed their policy as of July 1st. So it was noted and sent back over. Then they denied it for not having any new additional info but they hadnt l,ooked at the info. Yet another call and sent back. The last time they even had a medical reviewer look at it before sending it for review and she said it looked like everything was there. This time they took my phone number and said they would call me back by the end of the day with an answer. Of coarse it took 3 days of me calling morning and evening but finally this morning I got my Aprroval!! Hopefully I will update this soon with my surgery date!:thumbup:

Got my date!! August 30th!!! so excited!!!!will be on a liquid diet for my County Fair (we show animals and stay there all week) and for my birthday but it will be well worth it....This is going to be the best birthday present!!

I have my date!!! August 30th!!!! oh crap thats fast! they told me on the phone it was going to be a three week diet but I thought it was two so Im gonna have to ask. I think it is based on your starting bmi mine was 50 but I lost 40lbs in my 6 month diet so hopefully that will take me down to two weeks!

BCBS IL told me it was 6 visits and I was just approved friday with just the 6 visits.

hey guys.... just thought I'd let ya know that I finally got my approval from BCBS IL! they actually denied me based on investigational even though they changed their policy and I had to call them and tell them the policy had changed, 6 calls later they finally approved it!!

Lookin, tell her to just keep fighting! I know how stressful it can be! And how depressing, as I was denied a total of 5 times and each time I cried and screamed at the phone! If she can get to her policy online and read it so she can know exactly what they are looking for that helps! By the end I knew their policy better than they did! and had to tell them that they had updated it to include VSG. It depends on her specific p[olicy and her employers specific requirements! Good Luck to her! And to you it looks like you are doin amazing!

So I finally got my approval yesterday! Hoefully I will be sheduling Mon. For anybody going through BCBS IL here a warning they are denying the VSG for being investigational even though their policy has changed. I had to call them and tell them their own policy had changed. Maybe now that it has been brought to the medical reviewers attention it wont be such a problem any more! Good Luck All!

Grrrr BCBS is doing it on purpose now!! So I called to check on my status today only to have the girl freak me out by saying was was denied because of investigational, oh wait that was in February. Put's me on hold then tells me yes you were denied again but appearantyly they didnt look at my new info or their new policy! So she has sent it back for review with notes as to the new info!!! And I wait some more!

How long did your surgeons recomend you take off from work? I have a fairly physical job. It should be covered by short term disabilty as long as my insurance approves it so I dont have to worry about rushing back. just wonder what the norm is?

thanks guys! guess I'll just do whatever the surgeon recommends!

You can call them or look online with the code 43775 (VSG) to see if they cover the sleeve. I have BCBS IL PPO and they just updated their info JUly 1st to cover the sleeve. I have heard a lot of the BCBS are now starting to cover, and if they dont they usually cover once you appeal it....think it just depends on when they update their policy. did you find out the requirements for the medically necsarry clause...BCBS IL requires a 3 month diet documentation and some require 6.

Thanks guys...think Im just gonna start stalking them with phone calls starting monday!

My doctor has definitly not been a cheerleader. She has filled the paper work out for me but also lets me know that she has patients that have done it and gained weight back. My mother also goes to the same doc and had the lap-band and is now having complications so she asks me what I think about that. As we went through my 6 month diet I think she is more comfortable with it and understands I have done my research and know that this is just a tool. She did however ask at my last appointment if I was sure I wanted to do this because I had lost 40 lbs in my 6 month....like I havent done that too many times to count before just to gain it back and then some!

I am sooo in the same boat... except Im not approved yet so I really need to get my shi*! straight. I just got done with my 6 month diet ands all my paper work is in but what if they decide they want more from me! Even worse Im going on vacay on thurs to Chicago...mmm pizza. Going to be tough. Time to say goodbye to bingeing!

I know Lou but my stupid employer Walgreens requires a 6 month...I have been pretty bitter about that for the last 3 months!! but its over now hopefully my surgeons office will get it submited in the next week!

OMG I HOPE You"re Right... maybe my doctor not being on the ball is a good thing! I've been done with my 6 month diet doc which was the last thing I had to do but it is taking my doctor forever to get the info over to my surgeon so that I can send it in again! I just want to get approved and scheduled!! I lost 40 lbs on my 6 months but have been eating out of frustration and anxiety and put 5 back on! I just want to know if I am going to have to appeal or not!

Anybody got any recommendations on dealing with BCBS IL I have sumbitted everything once but did not have my 6 months of diet documentation. I am about to complete that and could use any info you having on getting approved. I had done everything 3 years ago and then found out I was preggers. Now I have been working at this again for 8 months and Walgreens(where I work) is requiring the 6 months its not even BCBS. Just want to make sure I get approved before my psych eval expires!

Congrats Lou... looks like I may need your help with an appeal.... if you have anything I could use I would appreciate it.

Lou ... I was also denied the first time they sent it through under that code. there is another code I dont remember what it is(it is a combination of 4,8,3and 0 but I am dyslexic and dont remember which order) I will see if I can find it. When they submitted it under that number I was just denied for not having enough diet documentation. BCBS requires 3 months but Walgreens requires 6. But they did tell me that it is a covered benifit under that code so try it, maybe you wont have to appeal just resumit under the other code!