Help! Need advice!

shandikiss · September 13, 2008

Hi everyone. I'm new to this forum and I am in dire need of advice. I have BCBSIL insurance and as many of you know, they require a 6 month diet. I did that. However... My Dr. kept telling me that it wasn't really necassary to come in every month for an actual visit, that I could just come by and weigh and he would record my weight. I explained to him about the insurance requirements and he assured me he would cover everything in my chart. ( I know, I should have stuck to my guns!) Now, I am in the process of getting my paperwork together to submit to BCBS and surprise, surprise.... my 6 month diet record..... CRAP! I do have a consecutive 8 month record, but there are 3 times when I only went by to weigh, so only my weight and lbs. lost are recorded. I honestly don't know what to do. Should I go ahead and submit my request now and fight the denial in appeal should it happen? ( I do have diabetes and a BMI of 56) or just do another 6 month diet and submit then? I have read horror stories about BCBSIL and honestly, I'm terrified! :wink_smile:

Savedbygrace · September 13, 2008

Hi! I don't have any experience with IL but I have BC of AL. My suggestion would be to have your doctor make a couple comments in the record stating that you lost/ gained x amount of pounds during that month and that you added more exercise etc... whatever . I am not saying lie about it.. I just mean ask him to document that you came in and what you had changed in that month. Then you should have it covered.

lessme · September 13, 2008

Definitely submit what you've got. I have Type 2 diabetes and I have BCBS. My BMI was 32 and I have high blood pressure and high cholestrol. The insurance covered the surgery minus the copay. I also included all of my exercise classes and documentation of all the diets I had tried. They only took a couple of weeks to tell the surgeon that they would cover the proceedure.

KayleighsMommy · September 13, 2008

Definitely submit what you've got. I have Type 2 diabetes and I have BCBS. My BMI was 32 and I have high blood pressure and high cholestrol. The insurance covered the surgery minus the copay. I also included all of my exercise classes and documentation of all the diets I had tried. They only took a couple of weeks to tell the surgeon that they would cover the proceedure.

Be glad (and thankfull as heck) you do not have BC/BS of IL. That would have NOT been enough for them. They really, really, really suck. :wink_smile: (Now should I tell you how I really feel?? LOL)

I'm glad your insurance came through for you.

julie

shandikiss · September 13, 2008

Thank y'all for the advice. I will go ahead and send in what I have. My Dr. did write that I came in to weigh and noted my pounds lost or gained, but that was it. If that's not enough and they deny me, then I'll definately appeal. I'm going to do what it takes to make BCBSIL pay. Afterall, that is why we all pay their high insurance premiums. Maybe they have forgotten that fact??? I can see that happening, being they forget what they have written in their own policies! :wink_smile:

*slim* · September 14, 2008

Thank y'all for the advice. I will go ahead and send in what I have. My Dr. did write that I came in to weigh and noted my pounds lost or gained, but that was it. If that's not enough and they deny me, then I'll definately appeal. I'm going to do what it takes to make BCBSIL pay. Afterall, that is why we all pay their high insurance premiums. Maybe they have forgotten that fact??? I can see that happening, being they forget what they have written in their own policies! :wink_smile:

I have BCBSIL and was approved on the first try. My doctor basically wrote that we discussed my weight and exercise and also noted my weight and bmi for each visit. If they deny it, just have him add more notes concerning your diet and exercise plan. I hope this helps.