Just denied by BCBS of IL...Help

[shawna_s 8]

Hi there! I am so frustrated right now! My insurance company told me that I need to have a 3 month "weigh-in" period with my primary with diet/exercise plan in place, etc., get the psych eval, and nutritionist. I did all of those things and they just denied me! My BMI was 37 at my first visit and unfortunately due to some hormonal problems I am having I have gained probably close to 10 pounds and I think my BMI is 38 now. The only comorbidity i have is asthma. No high BP or anything else. I haven't had labs drawn in awhile, so I am not sure what my cholesterol is, but I am wondering if i need to go eat a cheeseburger before i have labs drawn instead of fasting to get approved for the surgery... ha ha!

Anyway, my main question is this: Has anyone else been denied by BCBS of IL? If so, how long did it take to get things straightened out with them? I am so bummed right now!! I really don't want to wait another few months!!!!

[healthy and happy 64]

Hello Shawna,

I feel your pain. I have BCBS of NC. I had called my insurance company and looked up online to see what the qualifications were for being approved before i even began my journey. I met all the conditions. I was trying to hurry things along so I collected all my letters of support from my general physician, got a weight history from my doc to show that i had attempted to lose on my own, went to the psych visit, went to the informational session and to a support group meeting. I had a surgery date scheduled and had started liver shrinkage diet and BAM! My surgeions office called and said the insurance company denied my claim. I called and they said it was due to the psych visit they didnt feel i was ready for the lifestyle change. I called the psych and she said that her report to them indicated that i was a good candidate. She said that insurance companies often do this hoping that ppl will just forget about and not fight. Well, I fought. I called them and asked them to send me a letter of denial because I wanted to know exactly why they denied becuase I had contacted my congressmans aid to help me fight this. (that was not an idle threat, my brother in law just happens to be a congressmans aid), but low and behold my surgeion called them the next day and they overturned the decision immediately. August 11, I had my surgery!! Keep fighting it girl. They are testing you. I will say however that according to my BCBS stipulations if your BMI is between 35 and 40, you had to have 2 other medical issues as well to be approved, so you need to determine if you have high cholesterol or joint issues or sleep apnea. The only other choice would be if you gained a few more pounds and were 40 or more BMI.

Good Luck!

[shawna_s 8]

Hello Shawna,

I feel your pain. I have BCBS of NC. I had called my insurance company and looked up online to see what the qualifications were for being approved before i even began my journey. I met all the conditions. I was trying to hurry things along so I collected all my letters of support from my general physician, got a weight history from my doc to show that i had attempted to lose on my own, went to the psych visit, went to the informational session and to a support group meeting. I had a surgery date scheduled and had started liver shrinkage diet and BAM! My surgeions office called and said the insurance company denied my claim. I called and they said it was due to the psych visit they didnt feel i was ready for the lifestyle change. I called the psych and she said that her report to them indicated that i was a good candidate. She said that insurance companies often do this hoping that ppl will just forget about and not fight. Well, I fought. I called them and asked them to send me a letter of denial because I wanted to know exactly why they denied becuase I had contacted my congressmans aid to help me fight this. (that was not an idle threat, my brother in law just happens to be a congressmans aid), but low and behold my surgeion called them the next day and they overturned the decision immediately. August 11, I had my surgery!! Keep fighting it girl. They are testing you. I will say however that according to my BCBS stipulations if your BMI is between 35 and 40, you had to have 2 other medical issues as well to be approved, so you need to determine if you have high cholesterol or joint issues or sleep apnea. The only other choice would be if you gained a few more pounds and were 40 or more BMI.

Good Luck!

Maybe i will try the congressman thing. Not sure it will work for me, but maybe it will. The only thing that I know (or from what I can tell online) is that BCBS of IL changed their policy from 3 months to 6 months of supervised diet sometime in March or April, but they told my surgeon's office 3 months around June. Maybe I can get them for quoting me wrong info? I know it is a long shot, but man I am just so disappointed and tired of being fat!!!! I can't believe you had already started your diet and they said no! How frustrating for you! Glad they got it appealed for you!!!

**Oh and i have asthma and joint pain, but those are the only comorbidities. It is weird, because when I calculate my BMI online, it says it is 38 now, but when the nutritionist wrote my BMI down in her letter, it was 41.1?

[lizzy2150 3]

Don't point out the BMI discrepancy to anyone at BCBS!! Make them send you a letter, find out if the 6-month change affects you, and then re-submit your request! That's what I would do, anyway.

Maybe i will try the congressman thing. Not sure it will work for me, but maybe it will. The only thing that I know (or from what I can tell online) is that BCBS of IL changed their policy from 3 months to 6 months of supervised diet sometime in March or April, but they told my surgeon's office 3 months around June. Maybe I can get them for quoting me wrong info? I know it is a long shot, but man I am just so disappointed and tired of being fat!!!! I can't believe you had already started your diet and they said no! How frustrating for you! Glad they got it appealed for you!!!

**Oh and i have asthma and joint pain, but those are the only comorbidities. It is weird, because when I calculate my BMI online, it says it is 38 now, but when the nutritionist wrote my BMI down in her letter, it was 41.1?

[Grider 92]

Not for nothing but BCBS of ILL- is ont the radar alot on these blogs, maybe time to band together and send a letter to the isurance comish of your state. I have feblue fla, and I pray I am not jerked around like that. Not eating, fasting on milkshakes and a little nervous about the surgery,,, I may not be a a nice person- if denied for bogus info.. Lord help me, 2 mo to go,, peace,,,

[Lollicatt 36]

Per bcbs il, asthma is not considered a co morbity. Im not sure if joint pain is but I have bcbs il and if you're not 40+ you must have 2 qualifying co morbities. sleep apnea, high cholesteral, high bp, gerd, diabetes.

[shawna_s 8]

Per bcbs il, asthma is not considered a co morbity. Im not sure if joint pain is but I have bcbs il and if you're not 40+ you must have 2 qualifying co morbities. sleep apnea, high cholesteral, high bp, gerd, diabetes.

It just kills me that they wouldn't say from square one that " you don't qualify" instead of them paying for me to have the nutritional eval and psych eval and all of the freaking doctor visits. It is a waste of money for them to make it sound like it will happen and then deny, then to just deny it from the beginning.

[patyann 14]

I have BC/BS of IL *** - was denied the first time, second time went right through. It took me about 9 months from seminar to surgery though.

[pugsx3 39]

I have BCBS IL, and I did have to have 6 months of dieting. In that 6 months, I lost half of a pound. I also have high BP, asthma, and joint pain. I don't think they considered the asthma or joint pain, but I was approved last week after my first try. My BMI is over 50, so not sure if that played a part or not. I start my liquid diet Thursday, and will be banded 9/15. I can tell you from my experience, the last 3 months of the medically supervised diet were torture. I just wanted to get on with it. The nutritionist told me not to give up, as that is what the insurance company wanted me to do so they don't have to pay for it. Find out for sure if that is why they denied you and don't give up. It only took 3 days for me to get my approval once I gave them everything they asked for!

[shawna_s 8]

I have BCBS IL, and I did have to have 6 months of dieting. In that 6 months, I lost half of a pound. I also have high BP, asthma, and joint pain. I don't think they considered the asthma or joint pain, but I was approved last week after my first try. My BMI is over 50, so not sure if that played a part or not. I start my liquid diet Thursday, and will be banded 9/15. I can tell you from my experience, the last 3 months of the medically supervised diet were torture. I just wanted to get on with it. The nutritionist told me not to give up, as that is what the insurance company wanted me to do so they don't have to pay for it. Find out for sure if that is why they denied you and don't give up. It only took 3 days for me to get my approval once I gave them everything they asked for!

[/quote

Thanks for responding! The more I talk to people and research I am most certain it is b/c I only sent them 3 months of supervised visits instead of 6 and b/c my BMI is 38 and not 40, so i have to have more comorbidities. I am going to fight like hell to make this work!

[shawna_s 8]

I have BC/BS of IL *** - was denied the first time, second time went right through. It took me about 9 months from seminar to surgery though.

Thanks for responding! If you don't mind me asking, was your BMI over 40? I think that is going to be the deal breaker for me b/c I don't have any other comorbidity besides asthma.

[SIPS in Seattle 344]

I do not have the same insurance, however contact Walter Lindstrom's advocacy group in california. Obesitylaw.com I was denied by my insurance too, and they helped me.

It took two appeals and I was approved, I was under 40bmi w/ no real comorbidities either - well none that my insurance considered severe enough.

Good luck to you. Contact them, they're super helpful and the nicest folks.

[Lollicatt 36]

Shawna, do you have any updates? I can tell you that even if you started with only having to have 3 months, they have changed it and you will have to have 6 consecutive months. Do you have a true results in your area? That's where I'm going and they told me everything I needed to do upfront to get approved and are making sure that I get those things done before my 6months is up (last appt. 9/16 woohoo!) so I wont go through all of this and then be denied. Keep up your doctors visits because the one month you dont go...you have to start ALL over again. These insurance companies will find any loop hole they can to not approve you. I would also go find another sleep study place, you are being referred so your insurance should cover it.