bcbs of illinois

[DebraG 3]

I'm on my cell phone but I think I can post a link to the document:

http://medicalpolicy...t=Surgery#hlink

Thank you! this is the part I was refering to.

2. Evidence that comprehensive non-surgical treatment of morbid obesity has been attempted prior to surgical treatment of morbid obesity:

• Documentation of active participation in a comprehensive, non-surgical program of weight reduction for at least six (6) months, occurring within the twenty-four (24) months prior to the proposed surgery.
  

I had to prove that I had attempted to lose the weight and had participated in a program for at least 6 months. I am thankful I had been going to my doctor and she had kept great records saying we discussed diet and she had weighed me at each visit. I had the 6 month documentation...if they accept it.

They sent me a letter saying Weight Watchers, Nurtisystem, Jenny Craig, etc. were acceptable if I had done them 6 consecutive months. which I hadn't

[JessRess 14]

Debra,

Where do you see that part, I don't see it on the document- or is that what they sent you?

[DebraG 3]

Debra,

Where do you see that part, I don't see it on the document- or is that what they sent you?

Documentation of active participation in a comprehensive, non-surgical program of weight reduction for at least six (6) months, occurring within the twenty-four (24) months prior to the proposed surgery.

I found this in what you sent me.

[JessRess 14]

I see Debra, so no more physician supervised diet, but they still require a six month pre op diet. Booooo. That is NOT what they told me on the phone :-(

[Debra A G 3]

I see Debra, so no more physician supervised diet, but they still require a six month pre op diet. Booooo. That is NOT what they told me on the phone :-(

I hope I'm wrong but that's the way I read it and it is what they put in the letter they sent me and what they told me doc. It went into effect 2/1/12.

Sorry to disappoint you. I could have misread it.

[mandagay 93]

I am bcbs of Illinois and they first said I was approved back in November then called me a couple of days later and said I had to do six months with a nutritionist then a couple of months later they said "oh ur with Illinois bcbs" u don't need the six months". I had the surgery three weeks later (3-1-12).

[shawna_s 8]

I just got off the phone with the surgeon's office and she pulled up the policy. She said they don't require it at all and don't require the nutritional eval either, just psych! I am going back in for my reconsult 03/21!!!!!

[JessRess 14]

That's great news! Granted, my sixth appointment for the sixth month pre op diet is tomorrow... But I've been stressing that they'd deny me based on the fact that I've pretty much maintained the same weight...but if they've taken out the diet maybe it won't be as difficult...

[sissy24 2]

I have BC/bs of I'll and all my paperwork was submitted Friday. I had to do the nutrition and psych appt but the doctors office didn't ask me about prior weight loss programs. Hope I don't get denied. .... Ugh!

[JessRess 14]

It looks like they don't require the physician supervised diet anymore, Sissy, so you should be okay. I've already been denied once for the surgery a couple years ago and I have spoken with people who were denied several times before being approved. If they deny it, fight it! I know I will! Good luck!

[JessRess 14]

It looks like they don't require the physician supervised diet anymore, Sissy, so you should be okay. I've already been denied once for the surgery a couple years ago and I have spoken with people who were denied several times before being approved. If they deny it, fight it! I know I will! Good luck!

[cbreeden28 23]

I have BCBSIL and I started the process back in mid 2010. However, my BMI was too high for surgery and I couldn't get down to where I needed to be, so I just dropped it. The surgeon's office then contacted me in April 2011 and asked for another consult. I decided to go for it full force. I started my diet that month and she submitted the paperwork based on my previous appointments from 2010. At that time, they required 3 months supervised dieting and documentation of attempted weight loss with a program (WW, Jenny, LA Weight Loss). Then, in April, we found out their policy had changed to 6 months. My surgeon's office fought it since I had started the process in 2010. They then required me to do only 3, but it had to be 3 in the current year. So, I started in May and finished at the end of July. Paperwork was submitted in August and I was approved in about 2 weeks. My surgery was October 10th, but that was due to hospital scheduling, not insurance.

Overall, BCBSIL hasn't been too bad, but I did get denied my first go around for failing to provide required documentation (because they changed their policy). The second submission was approved. It does take their approval process longer. Most hear back in a week or less, but they are very slow.

[pink dahlia 2,513]

i have bcbs and had very good luck with them. i was 53 yrs old , 5'3 and 225 lbs with high bp, sleep apnea, and 1yr past history on weight watchers when my dr submitted all my paperwork last november. i got approved in a bout 3 weeks ! woo hoo ! i was banded dec 13th , 2011, and as of today im down 22 lbs and feeling great ! get as much documentation as you can to prove you've really tried, Drs personal note, past weight loss programs , nutritionist meeting etc.. Good luck !

[DebraG 3]

Hello, Hello, Hello,

I just spoke to bcbsil. They told me no physician diet but 6 months of comprehensive diet with documentation. I'm wondering if it depends on the group you are with. Such as: our insurance is through the company he works for. Maybe it varies.

I also asked them if they had made a decision on my surgery. They said they should have one by Monday. I know I will call again tomorrow. I'm so eager to know.

[JessRess 14]

I know how you feel Debra. My surgeons office got the paperwork from my pcp today so everything should be submitted to insurance today or tomorrow. I'm gonna start calling them right away. Good luck, hope you get good news soon!