Disheartened with BC/BS of IL

[Tammy M 0]

Hello all,

First post, but unfortunately I am frustrated. I know this is the holiday season, but I am sick of bl/bs of IL PPO.

I am at a 40 BMI. I found out that they denied my claim? WTF? All I read about here is how quickly bc/bs approves surgery.

The insurance guy called and said it was denied because I have no behavior modification program. Funny, the nutritionist talked to me specifically about behavior modification. I was 130 pounds and ran 5 and a half miles a day for over 20 years, and I ate well. I got hurt at work 3 years ago and gained almost 100 pounds.

Also they bc/bs guy said I have no exercise plan. Right this second I cannot exercise because of my back and knees. As soon as I lose weight, this may give me a chance to exercise. Unnfortunately, I'll never be able to run again because of a knee replacement. I can join a gym.

The last thing the insurance guy said that I have no support plan. I am going to a lap band support group if they approve this. If I have to join Weight Watchers, I will.

My doctor's medical records person is not dumb. She should know if bc/bs required that information.

I think bc/bs just wants to deny it not to have to pay for it.

Oh my husband's company is looking at other insurance companies, so I may get approved and not have that insurance any longer. I am beyond pissed.

Do any of you think I should continue to push this with my insurance company, or is a denial a blanket denial?

[MsRhonda 123]

I had bcbsil bmi was 45 three co morb. Did all requirments provided and got approved within 2wks but i did jave a glitch with them they had it on hold due to a letter inwhich they did recieve the clinic i went to said that they do that as a stall technique but nothin major bcbsil doent require a weight management the only thing they require is a psch eval surgeon approval dietican approval blood a visit try again appeal it

IM MY OWN MOTIVATION

[Tammy M 0]

I had bcbsil bmi was 45 three co morb. Did all requirments provided and got approved within 2wks but i did jave a glitch with them they had it on hold due to a letter inwhich they did recieve the clinic i went to said that they do that as a stall technique but nothin major bcbsil doent require a weight management the only thing they require is a psch eval surgeon approval dietican approval blood a visit try again appeal it

IM MY OWN MOTIVATION

Thanks for answering, but apparently bc/bs of IL does require a weight management. They did not even mention blood test. I have the psych eval and sent that to them. You are right, the dietician did talk to me about behavior modification. Ank how can I prove to them I will exercise?

[MsRhonda 123]

Idk i didnt have todo a weight program my clinic posted that on the web the beginning of this year saying bcbsil doesnt require that any more just the basic question where were u going for ur surgery ? I didnt have to do a exercise plan either all i did first day sry for no spaces on my cell. i went in filled out paper work which asked about have i tried any weight options i answered with all i tried from pills to exercise any co morb. yes

IM MY OWN MOTIVATION

[MsRhonda 123]

Asthma gerd weight was 278 bmi was in the 40s i then spoke with dietican she told me the run down told me to start this n that. Then came surgeon he Enlightened me on dos donts and any questions. Then since the pschy. Was on vaca i scheduled an outside apt passed that. To include vitals and hey that was that waited for my eval to come faxed to bcbsil then next thing u kno hey when u want todo your surgery I WENT WITH DAY ONE HEALTH CENTER awesome reasonable caring etc they even do free lapband contest check out website

IM MY OWN MOTIVATION

[Tammy M 0]

Asthma gerd weight was 278 bmi was in the 40s i then spoke with dietican she told me the run down told me to start this n that. Then came surgeon he Enlightened me on dos donts and any questions. Then since the pschy. Was on vaca i scheduled an outside apt passed that. To include vitals and hey that was that waited for my eval to come faxed to bcbsil then next thing u kno hey when u want todo your surgery I WENT WITH DAY ONE HEALTH CENTER awesome reasonable caring etc they even do free lapband contest check out website

IM MY OWN MOTIVATION

Day One Health Center is where I plan to go if approved.

[Tammy M 0]

Idk i didnt have todo a weight program my clinic posted that on the web the beginning of this year saying bcbsil doesnt require that any more just the basic question where were u going for ur surgery ? I didnt have to do a exercise plan either all i did first day sry for no spaces on my cell. i went in filled out paper work which asked about have i tried any weight options i answered with all i tried from pills to exercise any co morb. yes

IM MY OWN MOTIVATION

I am not talking about a weight management program before surgery. Yes, all insurance companies were mandated to stop that requirement in Feb. 1, 2012

[MsRhonda 123]

Day One Health Center is where I plan to go if approved.

The best

IM MY OWN MOTIVATION

[MsRhonda 123]

Idk confused ????i didnt have that problem and i have 100% coverage on every aspect with bcbsil and thats where i got my surgery done at awesome staff etc and yes u should appeal what did the finacial lady that handles it says.

IM MY OWN MOTIVATION

[MsRhonda 123]

U stated they do require it im a little confused tammy enlighten me please

IM MY OWN MOTIVATION

[DELETE THIS ACCOUNT! 12,703]

I would definitely appeal the denial. I really think you can win this.

Ok so he wants an exercise program post op? If I were in your shoes, I'd find the cheapest gym or YMCA near you, pay for a month, then submit it. Once you get the insurance approval you can let it lapse. Even if it costs you $50 with registration fees, it's still a heck of a lot cheaper than paying for the entire Lap Band surgery out of pocket.

Don't give up.

[Tammy M 0]

U stated they do require it im a little confused tammy enlighten me please

IM MY OWN MOTIVATION

U stated they do require it im a little confused tammy enlighten me please

IM MY OWN MOTIVATION

bc/bs said they needed to know what kind of weight management program I would be on after surgery. Bc/bs could have just said that thinking I won't appeal this so they don't have to pay for it.

[MsRhonda 123]

So u told the clinic u had no plan hmm.. they submitted that u need to appeal call the clinic n ask them they kno the hoops

IM MY OWN MOTIVATION

[Tammy M 0]

I would definitely appeal the denial. I really think you can win this.

Ok so he wants an exercise program post op? If I were in your shoes, I'd find the cheapest gym or YMCA near you, pay for a month, then submit it. Once you get the insurance approval you can let it lapse. Even if it costs you $50 with registration fees, it's still a heck of a lot cheaper than paying for the entire Lap Band surgery out of pocket.

Don't give up.

I'm not giving up. My life depends on this. I just don't understand why most people breeze through the approval process through bc/bs of IL PPO, and I am having a hard time. Sorry to be so whiney. I'm just afraid my husband's company may drop bc/bs soon. I need to get this surgery done asap. These holiday hours are really putting me behind. No one is working this week apparently.

[DELETE THIS ACCOUNT! 12,703]

You're not whining, your frustrated and are trying to get answers. It's completely understandable.

The reason may be with your husband's employer. Not all BC/BS IL are the same or offer the same coverage. It greatly depends on what the employer agrees on, and in some cases, they even have their own exclusions to coverage.