SunnyinSD

So I have been officially denied. This really sucks! I was denied because BCBS looks at the active policy from the date of approval or denial, not from the date of submission, so even though I completed and submitted the 3 months of Doctor supervised visits AND I send in the paperwork before the 15th of March when they changed the policy, they are STILL making me adhere to the new policy. I'm trying to decide if this is worth appealing or if I should just do the remaining 3 months of dieting. What do you think? I'm just pissed off! What was to stop them from holding onto my paperwork for as long as possible so that the decision hadn't been made by the time the policy changed, so that I would be automatically denied according to the terms of the new policy? What is they decide in 2 more months to change the diet requirements to 12 months? Like I said, I'm furious!

Here's an update on my approval status. I haven't been officially denied yet but I'm told that I probably will be. I was told that if the approval is still in process and hasn't been finalized before the policy changes that I have to adhere to the new policy - even though I had submitted to insurance AND completed the prerequisites before the new policy went into effect. So for now, I have to wait for an official decision and then appeal. SO stupid!!!!!

I know - the whole situation sucks. I called the day of the change and their reps were still in the dark. I had to specifically ASK what what going on, I was put on hold for over 15 minutes while the rep called around to find out, and then she confirmed that it had changed. I just can't believe that I'm more informaed about their insurance policies than the insurance people are. Scary, huh?

Still nothing yet from insurance on my approval. But... it's official - they changed the policy today from 3 months of dieting to 6 months. LAME!!!!

My doctor submitted to insurance today. I'm SO excited! I wanted to get in before they "might" be changing the diet requirements on the 15th. I'm submitting after 2 months of dieting but 3 visits (my doctor assures me that this is really what "3 months of dieting" means). Anyway, I'll keep you posted on my approval status.

I'm also going to be using Dr. Mueller. I haven't had the surgery yet - I'm on month 2 of the 3 month diet required by insurance. But so far, I love Dr. Mueller and his entire staff. Leti is my personal hero for working so hard to get my approvals completed before MArch 15th (my insurance is changing requirements on 3/15). So far, so good!!

I'm so sorry!!! That REALLY sucks! I will have to ensure that my doctor fully documents the exercise portion of the diet. Maybe it would help if your doctor resubmitted your diet info to include exercise. And they agreed to take only the 3 visits, not 3 months??! I'm over the moon about that little tidbit. Please note that as of March 15th, BCBS of IL will be requiring a 6 months weight loss program, not 3 months. So it's probably a good idea to try to have your doctor resubmit your old diet paperwork with some exercise stuff added in (I'm sure you talked about exercise, he may just have overlooked documenting it)

My starting BMI was 41 or 42 (I can't remember), but now I'm under 39. (I'm really rocking this pre-op diet) But I'm not concerned that I'm under 40 because the requirements for surgery specifically state that the starting BMI is what will be used when going in for approval.

I'm going to be submitting to BCBS of Illinois in the next 2 weeks. Please let me know how it goes for you! Also, a question - was your medically-supervised diet 3 visits each a month apart, or 3 months total? I'm worried because even though I will have done 3 visit each a month apart, I will have submitted to insurance after only 2 months (i.e. I went for my first visit on January 6th, the second visit on February 11th and the third visit will be on March 10th - but January to March is only 2 months). Thanks, and good luck to you!!