depressed

I have BCBS of Illinois PPO,they are really being a poop!!! any one else have any trouble with them? they tell me what to do I do it, then thats not right they need something else this has been going on for at least a week. Any one out there have any suggestions or thoughts on this matter??? Thanks for help/ 

Hi, I also have the same insurance. I called to see if they received my file and they had but said no proof of diet, not 6 months done etc. So I called and talked to someone else, who said it was the 6 month thing. So I called the surgeons office, she talked to them the next day and they told her something else. I gave it a few days and called got a really nice guy, he found the things in my file that the others could not. He also had my file re reviewed. He told me I need something from my PCP stating with my weights for the 5 years that I was morbidly obese at those weigts. He said once I have those in I will have everything. He even called me back at home to let me know what was needed. Keep calling find someone good, get their name and extention and let them help you. Keep calling if I hadn't I would still be wondering and waiting instead of working on the final thing they need. Hope that helps. BTW I did call and get their requirements sent to me through the mail. You can also find them at thier site online. I have followed all their requirements. Sometimes you just have to keep after them.

I have BCBS out of state. (Anthem/Ohio), but the first thing I did, before I even consulted  a surgeon, was consulted them to find out what I needed. enven down to where they reccommed I go.  I was approved within a week.  Lisa

I have done all that, and every time the Dr.s office and I make sure all is completed, they come up with something else,I had done so much research,called bcbs, had all the paper work completed, 6 months diet, and monitored, I mean everything, then they seem to think of something else. its just  is very frustrating, It will be resubmitted Monday. Wish me luck!!!!!

I have that insurance and they tried to say I did not have all the paperwork in so my surgeon requested a peer review with someone at insurance company. it worked because a week later I was approved

I have  BCBS of IL ppo and I was denied!  They said it was because I gained 3 pounds on my 6 month diet and that I have not been morbidly obese for 5 years.  And I don't have 2 comorbids because my bmi is 39.8......  I know how frusterated you must be!  My case is w/ a lawyer now and I am hoping to get approved!  Good luck..if you need anything, please let me know!!! Kim

Kim please keep,me updated. I hope I don't have to go the lawyer way, its all there in black and white, well just have to do a lot of praying, but I have been doing that anyway!!!!!!  I'll let you know;

I was approved in one day.  I use to work for Blue Cross.  If you go on line to bcbsil.com or call the number on the back of your card, you can search the medical policy manual.  Put in gastric bypass surgery.  It is all in black and white.  There requirements are: bmi over 40 5 year history of morbid obesity documented in med recs or a letter from your doctor stating that 2 comorbid conditions from the following list:  HTN, Diabetes, Sleep Apnea, Hypertention, CAD 6 month diet with nutritionist and primary care physician, never missing one apt for 6 consequtive months. Documented excercise in a log following an exercise program. Documented food log showing a reduced calorie diet, whether you lose or gain weight has nothing to do with denial as stated above. various attempts at other weight loss programs,  Tell them you also tried optifast or medifast. Pharmacutical therapy, etc...redux...fat blockers, meridia, phentermine etc... psychiatric clearance. A letter from your primary care physician of medical necessity. That is what is in your contract with Blue Cross.  If you do not provide them with what is listed above they do not have to approve the surgery.  I wrote a seven page letter spelling it out for them and going over each point, proving that I had met the criteria. Once again, I was approved in one day.  You don't need a lawyer, you just need to be aware of what they need to approve you, and you will be approved.  a letter of medical necessity from your

sorry about the typo's.  add hyperlipidemia to the list of co morbid conditions, remember all you need is 2 out of the 5.  If you do not have 2 out of the five, you may be approved if your bmi is in the severe morbid obesity range.  hope that helps.  Let me know how things are going for you.  if you have any other questions, email me.   Good luck.... Janet

So Janet are you saying that if you are not morbidly obese for 5 years, all you need is the 2 co morbid conditions?  Well...it IS in the lawyers hands now.  I guess I'll get the surgery one way or another.   All those medical terms confuse me...what are they in real people terms????

Thanks Kim