BCBC IL changed their web page today ...

[KabinKitty 11]

My surgeon has not submitted my paperwork yet. I have to do the 3 month supervised diet and that won't be complete till the middle of Sept.

Do you have BC/BS of Ohio too?

My surgeon said he has had a gal get approved for the sleeve and I don't think he even had to appeal. I think it's how he requests the sleeve when the paperwork is submitted. He does alot of explaining as to why the sleeve is the best choice for a particular patient. He's already told me that he does not want to do a GBP on me. If he was forced to, it would have to be open not laproscopic due to adhesions. YUCK!

He going to explain that my previous surgeries make the sleeve a safer surgery with better outlook for weight loss. Also, at age 58 the malabsorbtion is alot bigger issue!

[biancafg31 0]

if you have BCBS you are lucky since they updated their policy on July 1st, so no more explination needs.

I have Anthem BCBS and Anthem didn't update their policy yet so I need to appeal.

The lady in the doctor office that makes the appeal for me said that they had win appeals from Anthem in the past. Hope it will work for me as well. Can't get too confident tho.

[KabinKitty 11]

BC/BS of Ohio did not change their policy yet. I just checked the website and they are still considering the sleeve investigational and therefore are not covering it........yet. :mad0:

[myrori 55]

Hello,

I have been approved by bcbs il physically and pscychology. Can anyone tell what a comprehesive weight loss progam is? I have been losing since Jan down to 238 from 271 by following what my doc told me to do, but no real program per say. Will that be counted?

[KabinKitty 11]

You need to check with your provider or the surgeon's ins. person on this. I believe you have to have a medically supervised weight loss, but I'm no expert.

BC/BS is a stickler for following their policies exactly. I hope all goes well for you. My surgeon has a dietition that works directly out of his office. I am billed through the hospital and it's always $20, just like a co-pay. My surgeon has a very smooth running operation and I'm hoping for an approval sooner than later. I've jumped through all the hoops as far as he knows. Now I just wait and see if I get approved. His ins. gal is not hopeful that I'll get approved the first time.

[biancafg31 0]

Well guys, I am afraid I have no good news.

Anthem BC/BS denied my appeal level 1 as “investigational”. Surprise, surprise, right?

Even after I have all my papers, letters from my doctors that stated that I need to take NSAID and my surgeon office provide medical researches on my behalf, no dice.

Now I am fighting with them to let me bypass Appeal level 2 and go direct to Independent external review appeal witch I believe would be my best bet.

I feel that Appeal level 2 will provide the same results since Anthem is not looking at your medical problems they are just hiding behind the policy.

As I read this panel have three doctors independent of insurance panel that they look @ the medical necessity only. If they rule in your favor, the insurance has to cover your surgery, no questions ask.

The whole thing It’s depressing and frustrating especially when all other major insurance companies already updated their policy to include sleeve.

But I am still not giving up.

[thisislou 13]

Hello,

I have been approved by bcbs il physically and pscychology. Can anyone tell what a comprehesive weight loss progam is? I have been losing since Jan down to 238 from 271 by following what my doc told me to do, but no real program per say. Will that be counted?

Hi JCJC

This is what I had to do for BCBS IL.

They require a 3 month supervised weight loss program with your PCP. I had to go to him 3 consecutive months and document in his letter the dates of the visit, his recommendations, and my weight.

My doctor was very supportive of the whole process. I actually wrote the letter since I understood what BCBS needed and he signed it after the third visit. It does state in their policy that your starting BMI is what is used for the determination ? so any weight loss during that time does not count?. Hope this helps..

Lou