BCBS of Illinois

[cbreeden28 23]

Hi all!! I have been looking into the Lap Band surgery since June 2010. I attended the seminar and immediately filled out all the paperwork and mailed it in. I set up an appt with the bariatric naviagtor at the end of June. She informed me that my insurance required a 3 month supervised diet plan and documentation. I started weight watchers online the next day (a 3 month subscription). I did the 3 month's worth of dieting and weighing in with my doctor. However, my hospital was only approved to Lap Band those with a BMI of 47 or under. I was 53. I tried losing the weight over the next couple months, but couldn't get under their max. I had kind of given up on it when the physician's assistant called me earlier this month and wanted to know my status. I told her I was still interested, but couldn't lose the needed weight to qualify. I had already gone through all the pre-requisites (dietician meeting, psych eval, exercise consult), but couldn't lose the needed weight to qualify. She informed me that they upped their limit to 50 and wanted me to come in and talk with her.

Long story short, I'm trying again to get this surgery done. I had an upper GI last Tuesday to check for a hernia and am currently waiting on insurance approval. I have lost 7 pounds since starting this process about 2 weeks ago. I'm hoping to hear something soon from my insurance. It's like torture waiting on that approval. Does anyone have any ideas on how I will find out. Should I call my insurance or my surgeon's office or what? The assistant said it typically takes 2 weeks for an answer, but then I hear about people getting approved within a day. I'm trying to focus on my diet and losing the required wait, but if I got the approval, it would make me even more motivated.

[cbreeden28 23]

I just got a message from my physician's assistant that my insurance company, just 2 weeks ago, changed their policy from a 3 month doctor supervised diet to a 6 month. I'm so angry. My 3 month diet was done last summer, but it took some time to get everything else done and now, I have to start the supervised dieting all over again so I can have 6 months in a row. That means, I probably won't get approval until September. That is if I can get in to the doctor's in April. I'm so mad. Why do insurances policies constantly change? The assistant is going to try and fight it since I started this process last year, but they told her that they aren't grandfathering anyone in who had already started the process.

There is plenty of proof in my chart about my history of weight problems and that I've tried every diet known to man. Why do they need 6 months of dieting in order to approve my surgery. It's such a pain in the butt!!! :angry:

[dustbuster_00 0]

The insurance company really doesn't need you to prove that you have done 3 months of diet or six months of diet. Why did BCBS IL change their policy in March from a 3 month diet to a 6 month diet makes no sense to anyone other than the fact that they are trying to stall from paying for the surgery. They act like people are just going straight to the surgery instead of trying diet and exercise first. Geeze why didn't I think of that. I am going through the process now with BCBS IL I did WW online for 6 months consecutive last year. The two months prior to that I was on Nutrisystem. I submitted my Weight Watchers invoices and Nutrisystem invoices and they said that was not enough documentation. The insurance company is just trying to drag their feet even though I clearly meet the requirements.

This week i will be submitting my food journal for each day of the 6 month Weight Watchers diet along with an exercise log and weight loss log with a letter from my Primary Care Physician attached to it. I really hope this will suffice their documentation needs. I mean what else could they possibly want?

The insurance companies are a bunch of crooks who are just out there to make money off of you. They never want to pay for anything. Just look at your Explanation of Benefits. Your Dr. will bill them $200.00 and they will pay about half of that. They are sitting pretty with the oil companies making money off the poor and getting richer each day.

good luck to you, I hope that you get approved.

[Lisa75 3]

you have a surgery date, good deal. i'm really confussed as to why i'm seeing so many people who have started their weight loss diet for bcbs of il after i did and are getting approved. I was told my last visit that i have to wait for 8 months now. i just don't understand all this ;( good luck to you

[Lollicatt 36]

I have bcbs of il and today marks two weeks of waiting for insurance to hopefully approve me....