BCBS of IL decline

eudoetok · April 3, 2007

I called yesterday and was told by a rep from bcbs that they declined me for 2 reasons. 1. They said I need to have a 5yr history obesity, which i did all but one visit my BMI was 33 in 2002.. I asked them if they go by month so I know if I need to weigh in sometime this year to get my 5 years in. They had no clue. 2. They said I needed more information on being on a low cal diet. I went to my Dr for 12 months (found out it was only supposed to be for 6) to have weigh ins every month and she would memo that I was on WW or the 6 week body makeover. This was not good enough for them. I asked her what other proof I would need, she had no clue about this either.

Anyone ever have to go thru this? If so can you give me any info on what I should do. The surgern office was unsure right now on what to do, so I am asking for any help.

Thanks

faithmd · April 3, 2007

I was just denied a few minutes ago by a different company. Call your conpany and ask if there are complex case managers who handle bariatric surgery claims. I have one and she's been a godsend. We did everything right, but I was denied because I didn't lose what I needed to over the past year on the MD program (not my fault, but that's another thread).

Get the name of a case manager and then that person is the go-to person for you. S/he will be able to tell you exactly what you need to do.

good luck!

mikeomando · April 3, 2007

I was denied by BCBS of IL my first time too. After I was denied I joined the wellness program at Northwestern in Chicago to fulfill the 6 month supervised program requirement. One of the bariatric coordinators there then resubmitted my info, after talking to me and gathering some documentation. I was approved after this. You should carefully read the conditions for approval on the BCBS website, and see if you have any other qualifying conditions. For example, I was diagnosed with sleep apnea, and this was a factor in my getting approved. They don't make it easy, and you have to commit your time and money because some of the things they want (dietician consultations, for example) aren't covered by your insurance (or they weren't covered by my insurance, anyway).

You aren't the only one who has gone through this. I hope this helps.

Walter · April 8, 2007

If your insurance covers weight loss surgery but you have been denied, there is an appeals program that is of NO COST to you as a patient that you definitely should take advantage of. Contact your surgeon's office about it. If they do not know about this program (although they should!) they can contact our office to learn about this vital resource for patients seeking out the LAP-BAND. Good luck!

Walter Lindstrom

www.obesitylaw.com

LAP-BAND Appeals Advocates,

a program of the Obesity Law & Advocacy Center

kimbyrle · April 9, 2007

I just heard from BCBS of IL today that they need "additional details." I am as of this moment waiting for my "customer advocate" (as they so jokingly call themselves) to call back and tell me what the heck additional details they need. If I don't hear from her in another 30 minutes I guess I will try to call again.

I want to cry. I can't believe this process has been so frustrating.

tachlime · April 10, 2007

I've been waiting on BCBS of NJ to give us the go ahead and we keep hearing "no decision yet." My company's policy definitely covers bariatric surgery and I easily meet the criteria, but it's frustrating that his is taking so long. I hope the long wait isn't going to result in a denial or in more hoops to jump through.

kimbyrle · April 10, 2007

From everything I've heard, BCBS NJ is one of the worst to work with, as is BCBS IL. I have a coworker who had to spend months getting her husband's pacemaker approved because they kept giving her the runaround!

I found out that they wanted "more details" on my 6 month weight history. I am trying something that may work, but from what I've heard BCBS IL will find any excuse possible to not approve the surgery. So if it gets denied this time, I will have to start my 6 month history over again, and this time I will keep so much documentation it'll take a box to mail it in. :angry