I was just contacted by my surgreons office on Friday, regarding the requirements for Lapband surgery. I was prepared for lots of work ie..psych appt 6 month dr weight loss even a nutrionist and 5 year history of morbid obesity, but she seemed discouraged already. She told me that if you go below the 40 BMI during that 5 year period you are automatically excluded. I was shocked and got onto the bcbsil website and read the medical policies on the srugery. It did not say that you could not drop below 40 BMI. I read it as they just wanted to make sure you had weight issues for years not just a short period of time. She continued to state in 2 1/2 years she had gotten only one approval from this particular insurance co. I was getting discouraged, then later in the conversation she proceeded to tell me that honestly when most people find out about all the guidelines and the 6 mo diet they choose to go the self pay route. I think if it is worth doing you have to put some work into it, and that is what my insurance is for! I pay good money for it and think it is worth a shot to get all my stuff together and submit it. I was really just wondering if there were any experiences with this insurance and what was the outcome. Thanks for any advice you have. Tamara

Thanks so much for the reply. I was looking over my coverage and if I do stay overnight, it is covered 100%, so it might actually be worth it to get some rest that first night. Who knows.

Anyway, thanks again for the answer.

Ok, I am on pins and needles. My insurance coordinator called and said that she has faxed everything to BCBSIL. I can crossing my fingers, toes, eyes...everything. I am praying for an approval. :thumbup:

Good luck. The time can seem to go by slowly when your wanting something so bad. Hope to hear from you soon saying it's a go!!!!!

Good luck. The time can seem to go by slowly when your wanting something so bad. Hope to hear from you soon saying it's a go!!!!!

Thanks so much. Me too. I figure I am going to bug them to death until they just tell me yes to get me off of the phone!

Good luck! I would start calling them by Friday. I honestly called every single day from July 14th unitl my actual approval date last Tuesday. I was not harrassing I just called every day to check the status of the info. It was easier for me to know if they had all paperwork and who had the info and what stage of the review process it was in. I was the first person to know about the approval. I had to call the surgeon to tell them. Unlike some people on this thread I always had a rep that was more than happy to speak with me. One day we talked over an hour as she went over every single paper they had received. Good luck !!! It was not as bad as i expected. Tamara

Good luck! I would start calling them by Friday. I honestly called every single day from July 14th unitl my actual approval date last Tuesday. I was not harrassing I just called every day to check the status of the info. It was easier for me to know if they had all paperwork and who had the info and what stage of the review process it was in. I was the first person to know about the approval. I had to call the surgeon to tell them. Unlike some people on this thread I always had a rep that was more than happy to speak with me. One day we talked over an hour as she went over every single paper they had received. Good luck !!! It was not as bad as i expected. Tamara

Thanks. That is definitely a great plan. I just might put them on my speed dial.:biggrin2:

Thanks so much. Me too. I figure I am going to bug them to death until they just tell me yes to get me off of the phone!:thumbup:

I did the same thing and did most of the follow up and running for the things I needed by myself....I guess if you want some things done you need to do them yourself, huh?

I did the same thing and did most of the follow up and running for the things I needed by myself....I guess if you want some things done you need to do them yourself, huh?

This process is not for the faint of heart. If a person doesn't really want this, they would give up at the beginning.:eek: I guess that is what they want. They make it just hard enough that some people won't finish. I am not giving up.

This process is not for the faint of heart. If a person doesn't really want this, they would give up at the beginning.:cheers2: I guess that is what they want. They make it just hard enough that some people won't finish.:wub: I am not giving up.

I'd have to agree with your assessment whole heartedly. I got that impression while I was talking with them about my denial before PNC got involved and talked to them. They basically want to see how far you are willing to take the fight. And, it honestly pisses me off. If you really need this surgery to make yourself healthy and have passed all the requirements THEY say you must, they need to approve. But, they don't.

They don't look at the long term payouts they'll have for people morbidly obese. They look at the short term bottom line. It's f'ed up and they need to stop messing with people like this. :smile2:

When I went in for my initial consultation and told the nurse who my insurance was through, she just made a face and said we were in for the long haul. She knew exactly what to expect and told me what to expect from them.

I was also told that BCBS of IL is one of the hardest to get an approval on the first try.

I was also told that BCBS of IL is one of the hardest to get an approval on the first try.

I sure hope not. If that is the case, then I hope that I am the exception. I don't want to jump through any more hoops. I will if I have to, but I don't want to.

I sure hope not. If that is the case, then I hope that I am the exception. I don't want to jump through any more hoops. I will if I have to, but I don't want to.

Slim-n-tn...I also have BCBSIL the PPO plan and submitted my file on 8/21/08. Keep me posted on how things go and good luck! I'll keep you in my thoughts!

Slim-n-tn...I also have BCBSIL the PPO plan and submitted my file on 8/21/08. Keep me posted on how things go and good luck! I'll keep you in my thoughts!

I'll definitely keep you in my thought also! I will also add a few steps to my ancient insurance approval dance:biggrin2:.

After 2 denials and a peer to peer review of my Surgeon and BCBSIL medical Director that would not budge they (BCBSIL) sent my case out for an independent review with a Bariatric Specialist and they determined it was a medical neccessity and APPROVED me. I will be having my surgery Oct. 16th! They had never told me that they were sending it out for an IMR.

I did contact ObesityLaw and they told me that I qualified for a "free" appeal through Allergan. He said that my Surgeon just needed to request the paper work from Lap Band Allergan and they (Obesity Law) would represent me for free. I was luck, I never had to take it that far.

I had a BMI of 39 with co-morbidities of pre-diabetic, high blood pressure, arthritis and joint pain, and a family history of Cardiovascular disease. I did Weight Watchers for 6 months, although it was not "medically documented" I just had my booklet of my dates and weigh ins. I provided them with a 5 year history of my weights....not neccesarily MO but severely obese. I never went over a BMI of 40.

All I have to say is Do Not Give Up!!! Keep on them. I started calling them almost every day and they were giving me the run-a-round. If you talk to 10 Customer Advocates you will get 10 different reasons or explanations of what they need or want you to do.

I did the emotional roller coaster for 5 months. First denial came on my Birthday.........bummed me out good. One of the worst Birthdays I can ever remember but you know........Next year will be Kick a$$!

I wish you luck and all I can say is don't give up....if this is what you truly want keep on them.

Jeni

Way to go! I am glad that you were finally approved. I can only hope that I don't have to go through multiple denials. I have been calling them everyday. I have also been emailing them daily. I am not letting up. How exactly do you get in touch with Obesity Law if you need them?