I have been denied three times by BCBS of IL and now I have t write an appeal to go with my surgeons appeal. I was wondering if anyone else has been is this situation and what kind of things you said in your appeal. I am very frustrated at this point. I don't know how much longer I can do this. The approval process is very stressful. Any info would be appreciated. Thanks.

what did they list as the reason for denial?

I have BCBC Texas. I tried three different times in the last ten years and was denied every attempt even with appeals. It is very difficult. I made the choice to go "self pay". I made a few changes in my budget and got financing so that the payments are totally managable. Once I made that choice, it was such a releif. I am sorry you have been through so much. I wish you the best and hope you find a way to reach your goals even if insurance is not the option.

I was denied by BCBS of Texas, but it was because my employer had a clause that did not cover WLS for any reason. I did not fi d this out until I had gone through all the pre op testing requirements! That was 6 years ago. Last year I set up an appointment with the surgeon and had my surgery at my own expense. Best decision of my life!!!! This surgery is worth EVERY penny!!!!

That is what happened with me. My employer excluded the band and the sleeve from all health insurances provided. It seems silly, after all my research, gastric bypass is so risky and more expensive.

When going through the appeal process, it's important to stress the causal relationship between your weight and any co-morbidities which you may have. Also, emphasize the now well documented types of chronic illnesses which drastic weight loss helps to avoid.

Good luck...I hope you will be successful!

I have been denied three times by BCBS of IL and now I have t write an appeal to go with my surgeons appeal. I was wondering if anyone else has been is this situation and what kind of things you said in your appeal. I am very frustrated at this point. I don't know how much longer I can do this. The approval process is very stressful. Any info would be appreciated. Thanks.

I'm so sorry! Here if you need to talk or vent...

what did they list as the reason for denial?

They said they needed more paper work and the surgeon wasn't giving them what they asked for. But the surgeons office said they sent thm what they needed. so it was a big mess.

Thank you everyone all the support really helps.

Don't get discouraged the same thing happened with me...I am with Anthem Blue Cross Blue Shield. The first time I got denied because they said it was not enough information. Then the surgeon sent in more information from my regular doctor and the appeal was granted within two weeks. Don't give up

I would ask the insurance company for all the documents/test results they need. I would then go to each doctor who has those documents and ask for a copy. You may need to pay for them. Make your own copies. Find out to whom these documents need to be sent and send them yourself certified mail. You will then have proof they were delivered.

Yes I know your surgeon's office has someone who is paid to do this. Either this person is not doing their job or the insurance company is not doing theirs (ie loosing your information). If you remove one variable you will know the problem lies with the insurance company.