BCBS Illinois

[dlpfiff 0]

Sounds like we are in the same boat. Mine was submitted but they felt it was not detailed enough about the exercise portion so we are redoing the diet. I am sure going to make sure we talk about diet and exercise both in depth at my appointments. I don't want to leave anything to chance! I think I might write a letter to be included too. I've been this way my entire life and have been on every diet and exercise plan known to man. I wish they would take that into consideration.

[SunnyinSD 0]

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.

[AwesomeSleeve 5]

Good luck and keep us posted.

[SunnyinSD 0]

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!!!!

[dlpfiff 0]

Yep. I just called and was told it changed to 6 months also. I asked why I had been told by several people there that it was not changing and they had no answer for me! Of course.

[SunnyinSD 0]

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?

[MeMeMEEE 206]

I called today too Well I guess I am ok with it, wanted to wait at least til June after vacation so this pushes it to July but dang - how frustrating! They did clear up the documented medically supervised diet (or however it is said) for me - it has to be documented by the Doctor - so if you are doing weight watchers tell your Dr so they can document it in their records.

[gfawcetti 13]

Hello Everyone....

I don't post often, however my info was faxed over to BCBS of Ill this afternoon... fingers crossed!! I am soooooo nervous I won't get approved. My bmi was 40.3 the first weigh in with WW (which is what it specifically says in the material they sent me) however I was only 39.4 when I started with the surgeon. So I am scared that loosing that 5 lbs is going to ruin the whole thing! Any advice?? Do I have reason to hope?!

I am going to be a basketcase until I find out! Thanks for all your support even though I am not a big poster )

Glenna

[KinkySlinky 3]

Yep. I just called and was told it changed to 6 months also. I asked why I had been told by several people there that it was not changing and they had no answer for me! Of course.

Let me tell you what I would do if I were in your situation... I would call and speak to a supervisor and let them know that you have called MULTIPLE times in regards to this surgery and the diet plan required and you want the recorded calls to be pulled so they can verify what their customer service representative has told you... Oh, and if you don't get anywhere, continue to fight it going up the chain.... And then threaten to discuss this with your HR personnel at work and inform them that you have every intention of going up the chain with your employer as well...

They just might accept the 3 month policy if they recorded the call

Let me know how this works out for you...

[AwesomeSleeve 5]

The policy change is such a bummer but I truly believe everything happens for a reason.

[SunnyinSD 0]

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!!!!!

[SunnyinSD 0]

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!

[River King 3]

Yep. I just called and was told it changed to 6 months also. I asked why I had been told by several people there that it was not changing and they had no answer for me! Of course.

I feel lucky. I was BCBS Ill, got approved first time through after a 90 weight loss plan. Now during that plan I went to support group meetings, met a dietician, and did the phsyc visit. It seemed like I was at a doctor's office at least once a week. Good luck to those having problems, and don't take no for an answer.

[dlpfiff 0]

It seems like it is hit or miss with them. I also attended a support group meeting, met with a dietitian, psych eval and actually did a five month doctor supervised diet and still got denied. I am not giving up hope though.

[dlpfiff 0]

OMG you guys. You are not going to believe this. Ok...so I was denied in February becuase they said my doctors notes did not show that we had discussed exercise during my doctor supervised diet so my surgeon's office wanted me to redo the three month diet. Then the plan changed to six months. I was really, really down about it but decided I would go ahead and do the six months since I really didn't have a choice. I kept calling and getting advice from their customer service representatives and they kept saying if I could submit any additional information to please do so and they would review it. So...I decided to write a letter detailing my lifelong battle with my weight. I included all the diets and exercise programs I had been on and also informed them of the medical issues I was afraid of getting in the near future. I really didn't hold much hope that it would work but I figured what do I have to lose? Guess what????? I just found out this morning that I was approved! I cannot believe it! For those of you out there who are feeling down....don't give up. I was feeling really low but didn't give up and I made it work! You can do it too! Don't let them get the best of you.