BCBS IL Question

BigMomma1981 · October 4, 2008

I just turned in the rest of my records to the Surgery Center but I have a question. I have BCBS IL and was told that if I didnt have a BMI of over 40 for the last 5 years that I would be denied. I have the last five years to show weights but I was not above 40 all 5 years. I have been overweight all my life and can prove that but not over 40 BMI. I did the 6 months supervised diet with Weight Watchers and my PCP. Please HELP! I keep telling myself Im so close but I feel that they are going to deny and there will be nothing that I can do. :angry:

Thank you

illinoishusker · October 10, 2008

I don't know for sure. I know they did say that it had to be for 5 years for me. What does your surgeon's office say?

BigMomma1981 · October 10, 2008

It says 5 year history. The surgeons office said I should be okay but it may be denied initially and they will fight it out. They said BCBS is BAD for denying it atleast one time. I hope I hear something soon. Time will tell!!!

illinoishusker · November 9, 2008

Good luck to you. They didn't deny me, so maybe you'll get lucky too.

Marcy in Illinois · November 16, 2008

I have the same situation as you do. What did you find out about the 5 year history.

BigMomma1981 · November 16, 2008

:thumbup:Marcy in Illinois, I was approved within 7 days. They submitted past 10 years of records and it showed all the fluctuating weights plus I have some heart stuff going on so I guess that why it was approved so quick. I was banded 11/12/08 and feel pretty good. GOOD LUCK

Marcy in Illinois · November 16, 2008

Thanks for the reply!! I am just starting this journey. Who did your surgery? Do you have BCBS ppo plan. How did they pay? Is there anything you recommend me doing to push it through that might have helped you. I always like to hear someone else's story so that I don't do anything to make it a longer journey.

I am glad you feel good! Wear you very sore for very long after?

Thanks again and Good Luck!!

BigMomma1981 · November 17, 2008

Dr. Christopherson in Davenport, IA did my surgery. Yes, I have BCBS PPO plan and I had 10% Co-insurance until I met my yearly out of pocket max so it depends where your going and how much you will have paid out for the year. I would recommend doing the 6 month diet plan with weightwatchers and visit your doc every month for 6 months for weight loss evaluations. I didnt have much pain just the gas. I didnt use the pain meds to much and stopped them day 2. I had surgery at 7 am and was let go at 645 pm. THANK GOD the staff was GREAT!!!