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BCBS Illinois

dlpfiff

By dlpfiff, in Insurance & Financing

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myrori    55

myrori
Posted

I am really confused by all this,, I have BCBS of IL and I submitted last August and was approved right away with NO diet????

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KinkySlinky    3

KinkySlinky
Posted

I am really confused by all this,, I have BCBS of IL and I submitted last August and was approved right away with NO diet????

It's because your policy is different than theirs.. It's not the insurance company, or even the STATE of BCBS.. The requirements are SOLELY decided upon by your employer.. If your employer didn't require any hoops for you to go thru, then you don't have to.. If your employer wants employees to have a 6 month diet, then it will be required... I have BCBS, and my husband's employer only requires a BMI over 40...

What a lot of people don't realize is that the EMPLOYER makes the plan (in most cases), and the insurance company is just there to enforce the plan... But more often than not, the plan is chosen by the employer..

Hope this clears it up some :)

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KinkySlinky    3

KinkySlinky
Posted

Do you think a NP at the drs office is OK? It doesn't even specify a DR in my medical policy I printed online. It just says documentation of active paritipation in a comprehensive, non surgical program of weight reduction for at least 6 months.

Good point.. Usually plans will state "physician" supervised diet... Since yours is so vague, I would clarify with your insurance company... I'd hate for you to do all these weigh ins with an NP only to be denied...

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skinnynursebetty    23

skinnynursebetty
Posted

Good point.. Usually plans will state "physician" supervised diet... Since yours is so vague, I would clarify with your insurance company... I'd hate for you to do all these weigh ins with an NP only to be denied...

Ya me too! I think I will call them tomorrow before I go to my appt Monday! Thanks

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myrori    55

myrori
Posted

It's because your policy is different than theirs.. It's not the insurance company, or even the STATE of BCBS.. The requirements are SOLELY decided upon by your employer.. If your employer didn't require any hoops for you to go thru, then you don't have to.. If your employer wants employees to have a 6 month diet, then it will be required... I have BCBS, and my husband's employer only requires a BMI over 40...

What a lot of people don't realize is that the EMPLOYER makes the plan (in most cases), and the insurance company is just there to enforce the plan... But more often than not, the plan is chosen by the employer..

Hope this clears it up some :)

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myrori    55

myrori
Posted

It's because your policy is different than theirs.. It's not the insurance company, or even the STATE of BCBS.. The requirements are SOLELY decided upon by your employer.. If your employer didn't require any hoops for you to go thru, then you don't have to.. If your employer wants employees to have a 6 month diet, then it will be required... I have BCBS, and my husband's employer only requires a BMI over 40...

What a lot of people don't realize is that the EMPLOYER makes the plan (in most cases), and the insurance company is just there to enforce the plan... But more often than not, the plan is chosen by the employer..

Hope this clears it up some :)

This explains so much... I am guessing since my husbands employer administers claims for BCBS I was just plain lucky.

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KinkySlinky    3

KinkySlinky
Posted

This explains so much... I am guessing since my husbands employer administers claims for BCBS I was just plain lucky.

VERY lucky!! I hope I am just as lucky... My surgeon should be submitting my info soon

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gfawcetti    13

gfawcetti
Posted

Ok so I got the "official" denial letter today :( I knew it was coming because I had talked to them on the phone... I just called them back because the reason I was denied was the 6 months vs 3 months. I did find a weigh in book from 2009, but that isn't enough documentation because they need a medical professionals notes & signature!! I am bummed because i really want to get this done this spring... oh well. I guess waiting to re-submit till June isn't the end of the world, but it will cost me another $1000 in deductible (resets June 1, go figure) I am just so nervous that I won't get approved at all!!

Anyone else in the same boat??

Glenna

ps... I am going to write a letter to submit & see if my PCP will send one too, I figure I have until June I might as well send as much info as I can....

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skinnynursebetty    23

skinnynursebetty
Posted

Ok so I got the "official" denial letter today :( I knew it was coming because I had talked to them on the phone... I just called them back because the reason I was denied was the 6 months vs 3 months. I did find a weigh in book from 2009, but that isn't enough documentation because they need a medical professionals notes & signature!! I am bummed because i really want to get this done this spring... oh well. I guess waiting to re-submit till June isn't the end of the world, but it will cost me another $1000 in deductible (resets June 1, go figure) I am just so nervous that I won't get approved at all!!

Anyone else in the same boat??

Glenna

ps... I am going to write a letter to submit & see if my PCP will send one too, I figure I have until June I might as well send as much info as I can....

I'm sorry, that totally sucks! I know when you want something so bad and you are just left waiting and waiting it isn't fun at all. I just went to my dr today and didn't come in at the 40 BMI because the nurse measured me a half inch more than I had measured myself at home! I'm right at the borderline of 40 so I had my weight just right for my height ration and she went and screwed it up! Now I have to gain a few lbs to match the weight! SO bummed! I thought today would be the start of my 6 LONG months!!! SO, I know how it feels to be in limbo and just waiting! Keep your chin up June will come faster than you think! Stay positive and look to the future! FB

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SunnyinSD    0

SunnyinSD
Posted

Just curious - has anyone (besides me) appealed their denial because BCBS of IL switched from the 3 month diet to the 6 month? I'm just wondering if it's just me. Also, I'm hoping that they make their appeal decision faster than the 60 days that they have to decide. Becuase if they wait the entire 60 days, I might as well have not appealed and have just went ahead with the additional 3 months of dieting.

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dlpfiff    0

dlpfiff
Posted

Got my surgery date today. Woo Hoo! April 26th. I can't wait. Keep the faith everyone. It will be your turn soon!

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******    12

******
Posted

Got my surgery date today. Woo Hoo! April 26th. I can't wait. Keep the faith everyone. It will be your turn soon!

My date is also the 26th. Where are you having surgery? Who is your doctor?

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