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DENIED - Federal BCBS



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That does seem odd. The plan's terms and conditions should be available to you in writing. If your insurance policy is through work, and the benefits person at your work won't give you the Plan Document after you make a request (even better if you request it in writing), you can call the DOL and they can help. Employer sponsored health insurance is covered by ERISA. Good luck!

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Thanks. I can see that it's covered but can't get the info about what requirements I have. BCBS told me I had to do a 6 month supervised diet but when my surgeon's office checked they said I don't. I'm just concerned not having anything in writing and something is going to go wrong.

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Welllllll....I submitted all my paperwork on the 10th of May...and went ahead with the surgery on 5/17 as "cash pay"...because I had already taken soooo much time off from work in preparation for the surgery and other medical appts.

I received this letter from the Reconsideration department...which frustrates me...because they are looking for program participation between May '15 - present. My main argument for the reconsideration IS the lack of definition for "prior to surgery" verbiage.

post-291665-14639558176082_thumb.jpg

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Hi, looks like your insurance is BCBS IL Federal, (mine is basic) is that correct?

I have the same insurance and yes they do require 3 mon diet before the surgery. I had to do it.

post-269102-1463956527575_thumb.jpg

See the pic (from their benefits brochure online) this was from Jan 1 2016. Is it possible you make have a looked at the requirements of different BCBS of Il?

Edited by UsernameTaken

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I just have BCBS Federal (FEP). If you look at my earlier posts I have contested the wording in paragraph for medically supervised program...

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I just have BCBS Federal (FEP). If you look at my earlier posts I have contested the wording in paragraph for medically supervised program...

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True but it still says 3 months prior to surgery date right?

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The BCBS FEP advocate agreed that the verbiage leaves room for interpretation.

You read it as "3 months JUST prior to surgery"....I read it as 3 consecutive months prior (read BEFORE) surgery.

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    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 0 replies
      1. This update has no replies.
    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

      Officially here for a long time, not just a good time💪
      · 0 replies
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    • KimBaxleyWilson

      Three months and four days ago... I was in Costa Rica having a life changing surgery! Yesterday we had a followup visit with Dr. Esmeral via video chat and this morning my middle number changed.  I'm down 47lbs and two pants sizes. I can wear a Large tshirt for the first time in like... 14 years! Woot!! Everything is going great. I have zero regrets. I went down to the riverwalk with a friend and walked 2 miles on Monday without even getting fatigued. And no more snoring or chugging pickle juice for crazy leg cramps! I need to go to the gym more... I'm making new shirts next week so that will motivate me. LOL But I'm also just not as TIRED all the time! I have a LONG way to go...but seeing the progress on the scales and in the mirror is a huge motivator!! Thank you all for cheering me on and supporting me!!
      · 0 replies
      1. This update has no replies.
    • bellaamey

      https://alluniqueguide.com/java-burn-coffee-reviews/
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      1. This update has no replies.
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