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Denied AGAIN with BCBSIL

wannalose

By wannalose, in Insurance & Financing

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wannalose    0

wannalose
Posted

I am just devastated for the 2nd time! The insurance wants MORE information from my 6 month visits. They said the doctor was not descriptive enough. They want diet and exercise progress. I know what I discussed with my doctor in each visit but I can't control what she types in her records. I'm so frustrated now. I've been denied twice over this. I'll appeal but I'm scared this is going to go no where. My biggest fear is that I will have to find a whole new doctor and do another 6 months all over again. I've been on this for 9 months now. I just dont know what to do. ... Maybe curl in a ball in the room and cry?

Advise?

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sweety93    18

sweety93
Posted

Check your messages. I sent you a reply.

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MeMeMEEE    206

MeMeMEEE
Posted

Did you send more info or your Dr? I have heard of people writing a letter detailing everything themselves, not just what was discussed but what you did yourself - the Dr can write "Patient followed Weight Watchers" but you writing a letter noting the fact that you went to meeting for 6 straight months and lost X weight as well as walking on a daily basis or whatever seems like it would go a long way.

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gfawcetti    13

gfawcetti
Posted

Soooo.... I am trying not to be discouraged, however i am bummed. I got denied too by BCBSIL because the first month of my 6 month program with my PCP did not list my BMI. The first month I did the program was in April with a BMI of 40.8, then in May I was at a BMI of 39.8 so they considered the 39.8 the 'starting BMI' so I have to have the 2 co-morbidities. I am hopeful that when I have my PCP resend the note from April with the real starting BMI it will be approved since with a BMI of 40 I don't have to have any co-morbidities, but this is my worst fear... getting this far, getting this excited for nothing!

I have heard from some ppl on this forum that they were able to talk to the person at the insurance who is making the decision... how do I do that?? I was told today that I couldn't talk to the nurse!! Bummer... Does anyone have any advice??? I really want this done in November...

Thanks for listening, I was just hoping for better news :(

Glenna

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sweety93    18

sweety93
Posted

Do you have any prior months prior to your six months that showed a BMI higher than this. As long as you have a dr's visit w/i the past two years with a higher weight, please appeal w/that office visit records.

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sweety93    18

sweety93
Posted

Message me if you have any more questions.

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+change    5

+change
Posted

I was just denied for the 2nd time with BCBSIL also. My doctor is sending more about the 6 months program I completed through the hospital & documentation of my sleep study (which she normally doesn't include) & now I need everyone to help me pray I get an approval in the next few days. I understand how disappointed you are after 9 months.

Best of luck to you.

Jan

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+change    5

+change
Posted

I hope to share good news soon. I'm a native Texan living in OR & always appreciate the kindness of a fellow Texan. Take care,

Jan

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Ren<3    11

Ren<3
Posted

Awww dont cry nor give up<3 I've dealt with the insurance approval && 6 month diet psych eval && nutritionist also cardiologist started my process September 2010 its been over a yr so many times I've got denied because of a low bmi && no comorbidities I wanted to give up because of all these hoops im dealing with maybe its not meant to be maybe I should just give it all up but what helped me is all we have in life is time! why give up when time flys by anyways im finally waiting for my final approval then I will be sleeved soon best of luck to you keep fighting calling complaining you'll get approved<3

I am just devastated for the 2nd time! The insurance wants MORE information from my 6 month visits. They said the doctor was not descriptive enough. They want diet and exercise progress. I know what I discussed with my doctor in each visit but I can't control what she types in her records. I'm so frustrated now. I've been denied twice over this. I'll appeal but I'm scared this is going to go no where. My biggest fear is that I will have to find a whole new doctor and do another 6 months all over again. I've been on this for 9 months now. I just dont know what to do. ... Maybe curl in a ball in the room and cry?

Advise?

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gfawcetti    13

gfawcetti
Posted

Well, i am picking up the all the notes from my Dr about my 6 month program... with the BMI on each of them. I am also going to to add my personal letter to the mix to see if that helps. Then my insurance coordinator at the surgeons office is going to call the insurance company to see if she can get anywhere with them!! I am getting hopeful again that this will happen in November like I wanted in the beginning (because of my work schedule)

Glenna

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+change    5

+change
Posted

Keep calling BCBSIL every day & get a customer service rep that you like to call medical review for you. I was denied 3x & finally today I got my approval. It is such a good feeling & can't wait for my surgery 10-12. What a relief. Jan

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sweety93    18

sweety93
Posted

Awesome I'm sooooo happy for you. Congrats ;)

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