Denied by BCBSIL

Hello all, well I kind of figured this was going to be the answer, yes I was denied. Of all reasons, the 1200 calorie diet is not considered to be a very low calorie diet. Interesting that it does not say so on their requirements. They said the denial letter would be sent in the mail. Of course I could not be nice any longer at that point and informed them if I had to get other people in on this I would. So I guess the fight is on!

I'm so sorry, but you fight them and you will win! I think I am going to be screwed as well by BCBSIL because my NUT refuses to put me on a 1200 calorie diet, she says that it is WAY too low for me!  She's got me on a 1800 cal diet.  oh well, it would be just my luck too. 

Dear Renee: Sorry to hear that they are giving you a hard time.  I am sure that if it is not spelled out in their policy what a "low calorie" diet is, then this is just a stalling technique (which they can be very good at....). They hope that if they say, "no", you will just go away on the first try.  DON'T DO IT!!!! It may be as simple as asking for a supervisor or medical reveiw person and point out to them that the definition of "low calorie diet" is not in the policy.  If that does not fix it, ask your doctor (that you saw for the diet) to write a letter explaining why he/she chose that level of calories for you. When I dealt with them and my 6 month diet, the actual number of calories per day was NEVER mentioned, by me or by my doctor, and BCBS never asked.  I just wrote down what I ate in a typical day (once per month) as part of my monthly weigh-in. BCBS can be interesting to deal with and I think that it all depends on the luck of the draw and whose desk your file crosses on a particular day. Hang in there and DO NOT GIVE UP!!!!!  This is just a "bump in the road".

HI  Renee.    I, too have bcbsil and I was denied 2 times.  After the 2nd time, I wrote a letter pleading my case and had Dr. Lahmann's office fax it to the ins. company.  Finally I was approved.  My surgery was on Sept. 17 of this year.  Please do not give up!!!!! Jennifer Mietzner

Sorry Renee but you keep fighting.  Get your doctor's and surgeon involved.  Ask your surgeon to do a peer to peer review.  Whatever it takes.

Oh No Renee you better fight them... They just want to keep us all guessing as to what they are going to do isn't that sad. You fight fight fight and don't stop... Good Luck and Keep on fighting ..

I'm in your shoes right now also!!!  I was denied and my case is at a lawyers office right now!  Fight fight fight!!!!  1200 cal.... you can't get any lower than that!!  What BS!!!  PM me if you want to talk! Kim

I also am having a problem with BCBSILL,PPO they have not denied me, but it seems I never have enough, I believe you and I talked las week, I sent  25  pages of  very good documentation for years 2003;4,and first of o5 they had  recived info from last part of 2005,06 and 07  jumped through every hoop possible,they got back to my Dr. stating, a time laps in 2006 of 1,just 1 month that their was not a date of weight. Come on I have been over weight since I was 18 yrs of age, Have sent them probably a total of 100 pages of documentation explaining my health issues, my struggle over the years with weight lose, through  hundreds of diets,I have tried them all,my exercise routine, and how difficult it is to do because of "the weight", Have had double knee replacement not once,but twice in the last 3 years  and they   are concerened about 1 date in 2006, they are crazy, how dare them,that they have that much power to decide weather I live or die, I thought there was only ONE, in a Higher Place thst could make that decision......thanks for listening, guess I"m more up set than I thought!!!!!!!!!!!!! B.J.  Also when you look at your policy they do not state to the detail that they are digging into, IF they want that much detail, they better start changing they wording in the policies...........thanks for listening..( Boy I am testie today, better stay home and inside the house today,best for everyone concerened...."I  Believe"

Hello,  I am also a patient of Dr. Lahmann's. Ignore what it says on my profile. I have been working for about 1 1/2 year towards this.  BCBS of IL denied me 4 times until I finally got the appeal stage.  I hired Walter Lindstrom the Lawyer.  I just got my approval letter Thrusday and surgery is scheduled for Dec 10th. Yeah!!  He was about 450.00. And I am poor so it was hard but he does do payment plans.  Also if you don't want to go that route you can file your appeal and if they deny you can then go throught the IL Dept of Insurance.  So don't consider yourself beat yet.  You still have options.  Let me know if you have any questions.  Thanks! Kelly