Am I taking crazy pills?!

[jessress87 0]

Okay. Blue Cross Blue shield, with the help of my PCP's office has completely driven me to distraction!

I did my three month Dr. supervised diet, jumped through every single hoop they threw my way and they still denied me. Don't get me wrong, my surgeons office said they have never been able to get someone approved through BCBSIL on the first try.

I called BCBSIL this week to see if they could (or would) tell me EXACTLY what they want to see. The csr I spoke to was actually really helpful and went through all my paperwork. Basically he found everything they need but said that it needed to be in a different format in the doctors notes. Grrr.

I went to my PCP today for my 4th month visit and asked if there was a way for them to go back, take the info from the other appointments and put it in this different format.

Short answer: No.

My PCP was acting really defensive and kept saying that they would have denied me no matter what (which may be true) and that they sent everything they were supposed to. She said that BCBSIL is just being difficult and that I am just going to have to keep coming back until they finally approve me.

Long story short, she wants me to start weight watchers (which I have done before and lost weight but gained it all back...twice). So weight watchers it shall be.

I guess I just feel like BCBSIL is being difficult and my PCP is being difficult. Meanwhile my surgeon's office is insisting that what I need is another letter of medical necessity from my PCP, I specifically asked BCBSIL if that is what they need and they said no. I told my PCP and surgeons office about this and they both insist that they right. I know they are trying to help but I feel like their pride is getting in the way.

Did anyone else do WW for their supervised diet? If so, what documentation did you provide to insurance??

[sherrye22 0]

I'm sorry you are going through all this and hope I have better luck -- all my info will be submitted to my ins. company next week (Cigna). But I did want to interject that maybe you should consider switching PCP? Mine has been so supportive and is willing to do whatever it takes for me to get approved. Your doctor works for you, remember? Maybe find another one through this site, set up an appt. for a consulatation and let them know what's going on.

[GoneFishin 0]

I also have BCBSIL. Call Kelley @ Obesity Law and Advocacy Center If you have met all the requirements, the makers of Lap-Band will pay for them to represent you in appeal. Your surgeon must request the form from Lap-Band.

[Northern Mist 2]

As you will see in my thread - I started this process over two years ago!

This is what finally got me approved -

Weight Watchers daily logs had to be wrote on by my physician - EVERY SINGLE DAY. At my appointments I would bring in my logs I printed from Weight Watchers online and my doctor would make her suggestions and comments on every page. This was time consumming but I have a great doctor.

The daily logs consisted of Breakfast, lunch, dinner, snack and an exercise log. I put my food choices in and it calculated my points and I put my exercise activity and minutes in and it kept track of those too.

I had to show a progression EVERY month. Less points, more exercise and weight loss (even if its a little bit)EVERY month.

TIP:Start your exercise low and let the doctor write down her suggestions and then the next month make sure you follow her suggestions on the logs so BCBS sees you are following directions/rules. You can start out exercising pretty low but as long as you show "progress" your good.

This was the thing they were so strict on in my experience. All the other requirements were pretty cut and dry.

Paying for this surgery out of pocket would've strapped my family so fighting the insurance company was my only option.

Good luck and don't give up!

[Diamond In The Rough2 0]

I have never heard of anytone having to go through this. I would if at all possible find a PCP who wants to work in my best interest. They clearly are not working in yours. I have had to have Aetne call True Results and explain a copay issue. They will do that you know? Have BCBS call your PCP on a conference call, or have them call them directly and hash it out amongst themselves. This is what they are getting paid for. I feel it is an issue of pride with your PCP. BCBS knows what they need to approve. if it is given to them, there are no more issues. Again, I would switch PCPs.