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?

Well, after waiting a whole week, my surgeon's office was finally open. They refaxed all the information to my insurance company.

Blue cross is now requiring certain verbage in the letter that my surgeon sent to the. Now they requiring the the surgeon to include in his letter attesting basically everything that the dietician talked to me about. This is really redundancy. The medical records lady, Pricilla said she as 4 patients that were waiting for that exact letter.

Unforunately, my surgeon doesn't come in until Friday. I'm sure he will write exactly what they're now requriing. So I feeling my better that this letter will get me approved. Hopefully I'll have good news to report soon.

She will i have to get something fixed for my job n it will be handled when dr elli comes friday good luck okay

IM MY OWN MOTIVATION

Bcbs of fl wouldn't approve any of mine, I went on my husband's Aetna for the surgery and follow ups. I don't have the Aetna anymore, so I will be self-pay for any additional appointments. Good luck!

Bcbs of fl wouldn't approve any of mine, I went on my husband's Aetna for the surgery and follow ups. I don'tt have the Aetna anymore, so I will be self-pay for any additional appointm.ents. Good luck!

That really sucks. I don't have the money to self pay. If you not at a 40 BMI, most insurance comanies won't approve it.

That really sucks. I don't have the money to self pay. If you not at a 40 BMI' date=' most insurance comanies won't approve it.[/quote']

My BMi was right there and I also had sleep apnea as a comorbidity. I heard bcbs of fl is looking at adding it for school board employees here but they will have to jump through all of the hoops. It is worth it. I know my dr also would do payment plans as an option if you couldn't pay up front. Good luck. I know it's frustrating. I told my other drs for years that I was going to have the surgery. They kept telling me I needed to lose weight and acted as if I wasn't trying. It was very frustrating. Where there is a will there is a way!

I worked at BCBS of Il several years ago. Each employer group can choose their benefits. Self-funded groups have different options than other groups. You should file an appeal and try to find out specifically what you need to get approved. Message me your employer group and I might be able to give you some insight.