BCBS Illinois

[SunnyinSD 0]

I'm SO happy for you!! (And a little jealous) but it does give me hope that they will accept my appeal!

[skinnynursebetty 23]

I have bcbs il, but my husbands employer also has a say in the review. I did not have to do the 6 months diet before hand and once I jumped through all the hoops for the surgeon it and they submitted my papers I was ready to go in two weeks!

Your husbands employer wasn't UPS was it? My hub works for UPS and I'm so worried I'm not going to get approved for the surg!

[gfawcetti 13]

Well, I was officially denied this morning too ( I am bummed, but had tried to prepare myself for it... Anyway, I have done WW in the past 24 months, in addition to the last 3 months so i am going to dig up those old weigh in books to re-submit. I talked to the Ins person at the surgeons office and she recieved 4 denials this morning from BCBS of IL so lots of ppl are in this boat. She said that if I can find the weigh in books she will send in the appeal with new information so I am off to clean my closets LOL

I will keep you posted!!

Glenna

[wannalose 0]

I have BCBS Illinois as well, I was told I needed 6 months of a weight loss program i.e. WW/Jenny Craig. I started WW back in January so I'm just continueing the WW through June. Do you know if they will accept it with Gaps? I have weighed in at least once a month but there are a few weeks here and there that I haven't weighed in. I hope that doesn't matter. The Lady at the bariatric center doesn't seem to think there will be a problem but I will be devestated in June if I get denied going this far. I suppose I can weigh in from now on once a week since I'm paying for it.

[skinnynursebetty 23]

I have BCBS Illinois as well, I was told I needed 6 months of a weight loss program i.e. WW/Jenny Craig. I started WW back in January so I'm just continueing the WW through June. Do you know if they will accept it with Gaps? I have weighed in at least once a month but there are a few weeks here and there that I haven't weighed in. I hope that doesn't matter. The Lady at the bariatric center doesn't seem to think there will be a problem but I will be devestated in June if I get denied going this far. I suppose I can weigh in from now on once a week since I'm paying for it.

I have been talking to the insurance co everyday to just get things clear for myself and I think, but don't quote me on this that is just has to be 6 mo. The lady at BC told me I could go to my own dr once a mo and have them document the nutrition, exercise etc and that would suffice. HTH, Beth

[wannalose 0]

I have been talking to the insurance co everyday to just get things clear for myself and I think, but don't quote me on this that is just has to be 6 mo. The lady at BC told me I could go to my own dr once a mo and have them document the nutrition, exercise etc and that would suffice. HTH, Beth

I'm reading all these comments on insurance and I'm getting so scared. I started WW back in January and the first time this year I went to my Doctor was last month. I told him what I was doing and that I was doing WW. I was told by the girls that handle the insurance at the Bariatric clinic that all I should need is my WW book showing that I go at least once a month. Now I'm wondering if that really is enough. I'll call the insurance company tomorrow. I'm being very paranoid but I would be devastated after 6 months of going through this to find out I was DENIED. It's bad enough I see people after their 3 months behing Denied but 3 months? YUCK.

[dlpfiff 0]

I just think you never know for sure what's going to happen. I wonder if it just depends on who reviews your information. My info was submitted when it was a 3 month diet requirement. I had done a 5 month doctor supervised diet and also submitted 2 months of weight watchers weigh ins (weighed weekly) and I got denied. But, I hear other people say it was a piece of cake for them so I think you just never know. Maybe sometimes people are cranky when they are reviewing them or something!

[wannalose 0]

I just think you never know for sure what's going to happen. I wonder if it just depends on who reviews your information. My info was submitted when it was a 3 month diet requirement. I had done a 5 month doctor supervised diet and also submitted 2 months of weight watchers weigh ins (weighed weekly) and I got denied. But, I hear other people say it was a piece of cake for them so I think you just never know. Maybe sometimes people are cranky when they are reviewing them or something!

Do they tell you why you were denied? That doesn't make sense if you have a BMI of over 40 and you give them the requirements they need. I'm going to be making some phone calls in the morning. I can't do this for 6 months to get denied. It will ruin me. The waiting is the hardest part! Love these Boards, Very supportive. Thanks

[dlpfiff 0]

I was denied because they said my doctor and I didn't discuss exercise enough during the supervised diet. We did discuss it and both he and the surgeon's office felt his notes were sufficient but they still denied me. Also, my BMI is over 50. I think you just never know what they are going to say. What I ended up doing was writing a letter with all the reasons I felt I needed the surgery, which included all the diets and exercise plans I had been on over the past 30 years and I sent it to them. I also noted what exercises I had been doing and how often over the past two years. I made sure I gave a TON of detail in this letter They say they will take any additional information you have and will review it if you are denied. I did not file an appeal, just submitted the letter after I got my denial letter. Shockingly, it worked and they approved me. I was very surprised. It might not be a bad idea to include a letter with your initial paperwork and see if helps get you approved. I think the more information you give them, the better.

[wannalose 0]

I was denied because they said my doctor and I didn't discuss exercise enough during the supervised diet. We did discuss it and both he and the surgeon's office felt his notes were sufficient but they still denied me. Also, my BMI is over 50. I think you just never know what they are going to say. What I ended up doing was writing a letter with all the reasons I felt I needed the surgery, which included all the diets and exercise plans I had been on over the past 30 years and I sent it to them. I also noted what exercises I had been doing and how often over the past two years. I made sure I gave a TON of detail in this letter They say they will take any additional information you have and will review it if you are denied. I did not file an appeal, just submitted the letter after I got my denial letter. Shockingly, it worked and they approved me. I was very surprised. It might not be a bad idea to include a letter with your initial paperwork and see if helps get you approved. I think the more information you give them, the better.

Good Call! I'm going to call tomorrow and talk with my insurance company, Let them know what I'm doing and if it will suffice. See, I've only talked to my Doctor once! He's not even going over any supervised diet with me, he just ran bloodwork and I told him I was doing WW. I am thinking I may want to go see him again soon and keep up with that. Can I quit WW and submit what I did with WW and go to just the doctor? I know your not insurance experts but the advise is really got my thinker thinking.

[skinnynursebetty 23]

I was denied because they said my doctor and I didn't discuss exercise enough during the supervised diet. We did discuss it and both he and the surgeon's office felt his notes were sufficient but they still denied me. Also, my BMI is over 50. I think you just never know what they are going to say. What I ended up doing was writing a letter with all the reasons I felt I needed the surgery, which included all the diets and exercise plans I had been on over the past 30 years and I sent it to them. I also noted what exercises I had been doing and how often over the past two years. I made sure I gave a TON of detail in this letter They say they will take any additional information you have and will review it if you are denied. I did not file an appeal, just submitted the letter after I got my denial letter. Shockingly, it worked and they approved me. I was very surprised. It might not be a bad idea to include a letter with your initial paperwork and see if helps get you approved. I think the more information you give them, the better.

Good Call! I'm going to call tomorrow and talk with my insurance company, Let them know what I'm doing and if it will suffice. See, I've only talked to my Doctor once! He's not even going over any supervised diet with me, he just ran bloodwork and I told him I was doing WW. I am thinking I may want to go see him again soon and keep up with that. Can I quit WW and submit what I did with WW and go to just the doctor? I know your not insurance experts but the advise is really got my thinker thinking.

The lady at BC told me WW would be good and then I explained to her how expensive it is ($15/wk or something). Then she told me why not just go to the dr and make sure he is documenting everything they "require", for my regular copay. I asked how often I would have to go and she said once a mo for 6 mo would be good. Now I know she is not a reviewer, but this is info I have gotten from a few of the reps at BC. Also my surgeons office told me it really does depend on who is reviewing your file. They had a mother and daughter everything the same and one got approved, the other denied. I'm looking forward to hearing from all you out there that have BCBS IL so we can compare info. Thanks for all your help and advice!

[dlpfiff 0]

What I have seen from most people, myself included, is that they did their diet with their doctor and went once a month for how ever many months are required by their insurance companies. I also believe that say your insurance is a 6 month diet, that it is actually 6 visits, which is actually only 5 months, not actually 6 full months. If that makes sense.

[skinnynursebetty 23]

What I have seen from most people, myself included, is that they did their diet with their doctor and went once a month for how ever many months are required by their insurance companies. I also believe that say your insurance is a 6 month diet, that it is actually 6 visits, which is actually only 5 months, not actually 6 full months. If that makes sense.

That would be great! I'm looking to do this ASAP like most on here are. I have just been discouraged with the diet part. I didn't know I would have to do that, I mean come on I have been on a "diet" for most of my life. I remember being a child and my mom taking me to Sears to buy plus size girls clothes. I could give the ins co a LONG list, but I guess that isn't good enough! SO, I will go to my dr and get it all documented and HOPE and PRAY it works. I wish everyone good luck! FB

[MeMeMEEE 206]

I was told this week it has to be documented by the Dr - WW is great but you HAVE to have your Dr visits for 6 months. She said that is where she sees people get tripped up.

[skinnynursebetty 23]

I was told this week it has to be documented by the Dr - WW is great but you HAVE to have your Dr visits for 6 months. She said that is where she sees people get tripped up.

Do you think a NP at the drs office is OK? It doesn't even specify a DR in my medical policy I printed online. It just says documentation of active paritipation in a comprehensive, non surgical program of weight reduction for at least 6 months.