Hello all,

First post, but unfortunately I am frustrated. I know this is the holiday season, but I am sick of bl/bs of IL PPO.

I am at a 40 BMI. I found out that they denied my claim? WTF? All I read about here is how quickly bc/bs approves surgery.

The insurance guy called and said it was denied because I have no behavior modification program. Funny, the nutritionist talked to me specifically about behavior modification. I was 130 pounds and ran 5 and a half miles a day for over 20 years, and I ate well. I got hurt at work 3 years ago and gained almost 100 pounds.

Also they bc/bs guy said I have no exercise plan. Right this second I cannot exercise because of my back and knees. As soon as I lose weight, this may give me a chance to exercise. Unnfortunately, I'll never be able to run again because of a knee replacement. I can join a gym.

The last thing the insurance guy said that I have no support plan. I am going to a lap band support group if they approve this. If I have to join Weight Watchers, I will.

My doctor's medical records person is not dumb. She should know if bc/bs required that information.

I think bc/bs just wants to deny it not to have to pay for it.

Oh my husband's company is looking at other insurance companies, so I may get approved and not have that insurance any longer. I am beyond pissed.

Do any of you think I should continue to push this with my insurance company, or is a denial a blanket denial?

I had bcbsil bmi was 45 three co morb. Did all requirments provided and got approved within 2wks but i did jave a glitch with them they had it on hold due to a letter inwhich they did recieve the clinic i went to said that they do that as a stall technique but nothin major bcbsil doent require a weight management the only thing they require is a psch eval surgeon approval dietican approval blood a visit try again appeal it

IM MY OWN MOTIVATION

I had bcbsil bmi was 45 three co morb. Did all requirments provided and got approved within 2wks but i did jave a glitch with them they had it on hold due to a letter inwhich they did recieve the clinic i went to said that they do that as a stall technique but nothin major bcbsil doent require a weight management the only thing they require is a psch eval surgeon approval dietican approval blood a visit try again appeal it

IM MY OWN MOTIVATION

Thanks for answering, but apparently bc/bs of IL does require a weight management. They did not even mention blood test. I have the psych eval and sent that to them. You are right, the dietician did talk to me about behavior modification. Ank how can I prove to them I will exercise?

Idk i didnt have todo a weight program my clinic posted that on the web the beginning of this year saying bcbsil doesnt require that any more just the basic question where were u going for ur surgery ? I didnt have to do a exercise plan either all i did first day sry for no spaces on my cell. i went in filled out paper work which asked about have i tried any weight options i answered with all i tried from pills to exercise any co morb. yes

IM MY OWN MOTIVATION

Asthma gerd weight was 278 bmi was in the 40s i then spoke with dietican she told me the run down told me to start this n that. Then came surgeon he Enlightened me on dos donts and any questions. Then since the pschy. Was on vaca i scheduled an outside apt passed that. To include vitals and hey that was that waited for my eval to come faxed to bcbsil then next thing u kno hey when u want todo your surgery I WENT WITH DAY ONE HEALTH CENTER awesome reasonable caring etc they even do free lapband contest check out website

IM MY OWN MOTIVATION

Asthma gerd weight was 278 bmi was in the 40s i then spoke with dietican she told me the run down told me to start this n that. Then came surgeon he Enlightened me on dos donts and any questions. Then since the pschy. Was on vaca i scheduled an outside apt passed that. To include vitals and hey that was that waited for my eval to come faxed to bcbsil then next thing u kno hey when u want todo your surgery I WENT WITH DAY ONE HEALTH CENTER awesome reasonable caring etc they even do free lapband contest check out website

IM MY OWN MOTIVATION

Day One Health Center is where I plan to go if approved.

Idk i didnt have todo a weight program my clinic posted that on the web the beginning of this year saying bcbsil doesnt require that any more just the basic question where were u going for ur surgery ? I didnt have to do a exercise plan either all i did first day sry for no spaces on my cell. i went in filled out paper work which asked about have i tried any weight options i answered with all i tried from pills to exercise any co morb. yes

IM MY OWN MOTIVATION

I am not talking about a weight management program before surgery. Yes, all insurance companies were mandated to stop that requirement in Feb. 1, 2012

Day One Health Center is where I plan to go if approved.

The best

IM MY OWN MOTIVATION

Idk confused ????i didnt have that problem and i have 100% coverage on every aspect with bcbsil and thats where i got my surgery done at awesome staff etc and yes u should appeal what did the finacial lady that handles it says.

IM MY OWN MOTIVATION

U stated they do require it im a little confused tammy enlighten me please

IM MY OWN MOTIVATION

I would definitely appeal the denial. I really think you can win this.

Ok so he wants an exercise program post op? If I were in your shoes, I'd find the cheapest gym or YMCA near you, pay for a month, then submit it. Once you get the insurance approval you can let it lapse. Even if it costs you $50 with registration fees, it's still a heck of a lot cheaper than paying for the entire Lap Band surgery out of pocket.

Don't give up.

U stated they do require it im a little confused tammy enlighten me please

IM MY OWN MOTIVATION

U stated they do require it im a little confused tammy enlighten me please

IM MY OWN MOTIVATION

bc/bs said they needed to know what kind of weight management program I would be on after surgery. Bc/bs could have just said that thinking I won't appeal this so they don't have to pay for it.

So u told the clinic u had no plan hmm.. they submitted that u need to appeal call the clinic n ask them they kno the hoops

IM MY OWN MOTIVATION

I would definitely appeal the denial. I really think you can win this.

Ok so he wants an exercise program post op? If I were in your shoes, I'd find the cheapest gym or YMCA near you, pay for a month, then submit it. Once you get the insurance approval you can let it lapse. Even if it costs you $50 with registration fees, it's still a heck of a lot cheaper than paying for the entire Lap Band surgery out of pocket.

Don't give up.

I'm not giving up. My life depends on this. I just don't understand why most people breeze through the approval process through bc/bs of IL PPO, and I am having a hard time. Sorry to be so whiney. I'm just afraid my husband's company may drop bc/bs soon. I need to get this surgery done asap. These holiday hours are really putting me behind. No one is working this week apparently.

You're not whining, your frustrated and are trying to get answers. It's completely understandable.

The reason may be with your husband's employer. Not all BC/BS IL are the same or offer the same coverage. It greatly depends on what the employer agrees on, and in some cases, they even have their own exclusions to coverage.

So u told the clinic u had no plan hmm.. they submitted that u need to appeal call the clinic n ask them they kno the hoops

IM MY OWN MOTIVATION

No, I told the clinic that a formal exercise program would be difficult for me because of my worker's comp back injury. I told her my doctor said if I could lose weight, a lot of my pain will improve and I may be able to exercise. I am just going to do what Missy said and join a health club.