I have surgery scheduled for 17 May 16. BMI is 39 - have Moderate sleep Apnea. Did medically supervised diet from Dec 2014 - May 2015 and every possible diet known to man, multiple times.

Reason for denial is that the 3 month medically supervised diet was not within this last year. Nowhere in the 2016 FEP BCBS brochure does it say WHEN you had to participate in a 3 month program. I was also medically supervised from Apr 2006 - Dec 2006 when I represented Pennsylvania on Season 3 of the Biggest Loser.

Can anyone advise on how best to challenge this? I don't want to wait another 90 days to check a block. I've been battling and battling and battling for years....

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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.

Any update?

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.

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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.

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 May 22, 201610 yr by UsernameTaken

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?

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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Hope they approve, glad you are fighting it!