DENIED (BCBSIL)

wannalose · June 10, 2011

I'm so bummed, I called the insurance company and was told that the information that I submitted was not enough. She said that the first 3 months of my diet was not supervised (I submitted WW) and that the last 3 months with my doctor was not enough detailed information. They want to know progress on my diet as to what I was eating and how much and exercise if I was doing 10 leg lifts a day and went to 15 a day each month. I'm so bummed. I called the insurance coordinator with our bariatric clinic and she said I must have gotten a really tough case worker. STINKS only me this would happen too right? ANyways, She's going to look at the denial letter when she gets it and sees if there is enough for an appeal. She thinks worst case scenario is I would have to do an additional 3 months to please them with the WW. Of course I thought I would have needed more then just a WW booklet but she claims they approve them all the time.

Such a sad day I need a pity party.

SunnyinSD · June 10, 2011

I'm so sorry! This REALLY sucks. Did they tell you what they were looking for specifically? I know I was told by BCBSIL that I HAD to do my weight loss diet period with medical supervision, which meant checking in with a doctor once a month. I just submitted for approval to them a few days ago and I'm hoping that I don't run into the "not enough documentation" problem. Gosh that would suck!

On a side note: I was denied 3 months ago when they switched from a 3 month diet to a 6 month. And the extra 3 months go by really fast. So, you'll be submitting again before you know it!

wannalose · June 10, 2011

Yes I spoke with the Claims person. She said that WW was not enough that I needed a doctor supervised plan. I started going to the doctor 3 months ago and the information she submitted wasn't enough. They wanted a food Journal and notes on how my exercise was for example if I could only do 10 leg lifts in one month then the second month I could do 15 leg lifts. That kind of documentation. When I spoke with my Insurance Coordinator at the Bariatric clinic she told me that I had a really tough claims adjustor and she was surprised they were being that strict but she was going to wait on the denial letter and see what I need to do. Just Bummed me out

Texasmom65 · June 14, 2011

Good Luck. I hope you get approval pretty fast. I was told the same thing about BCBS, but mine is of Texas with the TRS plan. They are pretty stricked too. But I was approved. I had enough info from the last 24 months with my PCP about my weight problems that it worked. I'm doing the WW too, since March and stated seeing my PCP monthly in April just to be on the safe side. I was shocked to know they approved me yesterday.

I'm having mine done with Dr. Nicholdson in Dallas on July 11th.