Well, I called BCBSIL today to see if a decision had been made yet and I was told that they need to see my 3 month supervised diet documentation. I told her that I know that my surgeons office has it and that I would have them refax it and she said that was fine.

I called my surgeons office and spoke to my 'insurance lady' there who said quite confidently that it's not that they didn't get it, it's that they are saying that what was provided wasn't detailed enough. I can't say that I'm shocked because I'm sure we've all heard about others having the same issue. What bothers me is that the girl with BCBS didn't say that- she didn't even use the word 'denied'.

The good-ish news is that my insurance lady said that they've never had someone with my insurance be approved on the first try. She said that they'll deny me twice and they may have to appeal before they finally approve it- they want me to back down. Well, Sorry Charlie, that's just not going to happen .

I must admit I'm a little bummed to know that this is likely going to drag out but at the same time I'm thankful that there is a light at the end of the tunnel. I'm going to keep doing whatever I have to do to get this surgery approved (as I'm truly not in a position to attempt any kind of self-pay).

Side note: Does anyone have the Wii Fit? My mom got it for me for Christmas. My mom was setting up her profile and everything and I was all excited becuase it was really neat. However, when I got on it it informed me in bright red text that I exceed the maximum weight limit, which I'm sure goes without saying, was humiliating! I know that I am hovering right around the weight limit but I didn't know that it was going to not let me use it. There are a couple ways to get around it but I mean to tell you, the first thing it does is it weighs you and if you exceed the weight limit it won't let you go any further. When we were using it yesterday I would have to have my fiancee stand on it before I could hop on and do any of the games.

Does anyone else find it ironic that a tool that is supposed to help you get healthy or lose/maintain weight has what I would call a pretty low maximum weight limit (330 lbs)?

annoying? yes. ironic? absolutely! but i am not surprised...it seems that the prevailing notion is that if you are beyond 330, then you are beyond saving and you might as well go drown your sorrows in some hagen daaz....

I have a Wii Fit, and I think it's kind of an asshole. I swear it groans every time I step on the damn thing.

As far as the insurance thing, I totally feel ya. I had to resubmit all kinds of crap that wasn't "thorough" enough. Just keep at it. Like you said, they want you to back down. If they can avoid paying for something, THEY WILL.

Just hang in there... be persistent. Obnoxiously persistent. The squeaky wheel gets the grease!!!!

lol- it says 'OH!' everytime anyone steps on it, it's kind of a jerk. And it asked my mom if she found herself tripping when she walked because her balance was off. I have to use someone elses avatar to actually go in and do anything- other than that it's okay.

Well, I called BCBSIL today to see if a decision had been made yet and I was told that they need to see my 3 month supervised diet documentation. I told her that I know that my surgeons office has it and that I would have them refax it and she said that was fine.

snipped

My advice, if this hasn't been resolved. Get copies and Fed-Ex them. You'll have tracking information that it WAS received by the insurance company.

Denise

Edited January 8, 201016 yr by Cocoabean
I really can spell!

The first time I submitted BCBS of IL said they didn't rec. it - I refaxed everything and called a couple days later to confirm. Then they told me it wasn't detailed enough the next two times I submitted.

BCBS recommends Weight Watchers but when I called and said I was on it and sending WW logs the representative on the phone wasn't sure what WW's was and asked what points were? and proceeded to tell me I should watch my calories and not these point things!! Argh!!!!

I talked to someone else that knew the program and they told me that I wasn't showing progression - so I had my doctor write her suggestions on every single days food and exercise logs for 90 days - I exercised more, cut my calories and lost a little weight every month. This is what finally worked for me.

They will give up - don't stop trying!