I need help

Hi, I am new here. I have a support person Kathy who is a regular here and suggested I come here for some help. I am trying to get approved, but was told today I was denied. I have Blue Cross HMO of Illinois ins. Does any one else have this insurance and if you do, what did you do to get approved. I have many medical problems because of my weight, but they don't care. They seem to think 3 years of monitored dieting is more important. Which I don't have. I just faxed my former physician and asked if he'd send a letter saying I was dieting while under his care. Which is the truth only he wasn't monitoring it or making me do anything in particular. Any suggestions or ideas would be very much appreciated. Thanks...

Hi Mary! Nice to meet you. Kathy is great, isn't she? I can't help you with HMO, but I have BCBS of IL PPO, and was originally denied because my company had an exclusion. Upon appeal by my surgeon (not me, not my PCP) who deemed this a medical necessity, I was approved. These insurance companies are so finicky. I thought Blue Cross just changed its policy that only a 6 month medically supervised diet was required (maybe not for the HMO though)? I'll look into that. Blue Cross has also designated specific hospitals "Centers of Excellence" ... I also believe you're more apt to be approved if you use one of them (Northwestern happens to be one, I'll try to find out which other ones are as well). If nothing else, get started on a supervised diet with your PCP now (because if it IS 6 months, you'll have a head-start), BUT ... find out what BLue Cross requires ... they may need you to do into the doc's office every week or month for an official "weigh in" ... or may have other hoops you need to jump through. So, I think by contacting them and just asking them what their criteria is to be approved, might speed things up for you. Hang in there ... let us know how its going ... I'm having a clothing exchange/jewelry party on Saturday, and if you're available and would be interested, email me and I'll forward details. Best wishes to you Mary!! Karyn

Thanks for all your input. I did call BC and they said each site has their own policy. Having the HMO makes it different from regular BC coverage. The HMO's are very fussy and will nit pick. I'm told if we appeal we should be approved. My doctor is digging in my medical records for stuff to include. I've only been with her for 6 months so she has to do some major digging. I have tons of medical problems and you'd think they'd approve it on that alone. I was told too many people are trying to get this procedure done just to loose weight. That's why they're so strick. I'll keep you posted. Keep your fingers and any other body parts you can cross for me.

Hey Mary ... if you're like most here, you probably have endless attempts at weigh****chers, Jenny Craig, and other various ... although they may not have been medically supervised, definitely have your doc put them in there. Thoughts, cares, and prayers to ya girl ... sounds pretty hopefully that an appeal might work!! Karyn

Hi Mary - I e-mailed you earlier this morning. Hope to hear from you soon. Christina