Lost Cause???

Okay ..here it goes. I have checked with BCBS IL with all of their rules and regulations in regards to the weight loss surgery. I am aware of the co morbidities (which I have a lot of them) However, one of their stipulations is that I need to have 5 years of documented proof. Well, I think I may be able to dig some up..but I did not go to a doctor on a regular basis until the end of 2005. In 2004 my back gave out and I went to a doctor in the previous town I used to live in. That was only once in the year. 2005 I want to a doctor which is a general doctor, however I rarely see him. The people that handle my main problems are my neurologist and my gyno. Since they are the ones handling all of my problems, I saw no need to go to the regular doctor. The only thing he would probably say is "That is something you should ask your gyno/neurologist b/c they are handling it" He is a very good doctor, and has helped me with a lot of other issues, but everything that needs to be done with me is being treated by someone else. I just know that I am a good candiate for it b/c I have a BMI of 50, and have a lot of co morbidities. My only fear is them pretty much knowing that I may drop dead at any time but not caring just b/c I have only had 2.5 years of the documented weight loss.  I know insurance companies are sticklers- my mom fought for 4 years with hers before she got approved. Has anyone had any experience with thier insurance company where they have been denied and appealed and found a light at the end of the tunnel (even though you may have not had EVERYTHING  they wanted.)

Welcome to the board.. First off, to the best of  my knowledge, the insurance company is not looking for a weight loss in that five year history.  They are looking to see if you were obese, mo for a long period of time and that the weight your at today did not just happen over night. Any records showing your weight will do.. it does not have to be your family doctor.  So if you have records from your neurologist or gyno you will be on your way.

Good Luck, Christina

I have BCBS of IL PPO. I also had the same struggle due to not going to doctor regularly. They just want to see that you were obese. I got records from anyplace that took my weight!! They tried to fight me on it when I went for approval but my surgeon did a peer to peer review and I got approved. Good luck

i am keeping your fingers crossed that they approve you soon!  i don't understand these insurance companies at all.  my girlfriend has the same insurance as you and has been trying to get approved since before i even started this journey.  my husband words for the federal goverment so my doctor's office tells me that bcbs federal gov. you get approved right away if your bmi is over 40, which mine is.

I have BC/BS of Ill too and you just need documentation of a doctor's weight. I have been seeing the same doc for over 5 yrs and everytime I go in they weigh me and most docs do.  All you need to do is make sure when your packet is sent in that you have EVERY doc you have seen in the last 5 years listed. They will get the records. I printed up the requirements for my doc so when I was doing my 6 month diet he knew exactly what to write. The one thing he did and I am so glad he did was have me have the sleep study the first month of my diet and it turns out I have SEVERE sleep apnea so I got CPAP and can't believe how much that helped me feel better. Just make sure you start the 6 month diet either with your reg doc or a group that is with your surgeon and you shouldnt have any problems getting approved. Good Luck to you!!!

I too have BCBS PPO. I just completed the 6 month weight loss thing april 3. I did the psych eval 4/17 and just this week my paperwork was submitted to insurance. I spent a LONG time organizing my records. Some docs destroy them after 5 years... I dont even know if that is legal??? But, I had to really think back to any little visit I had including er visits. I submitted for '99,'00,'01,'02,'05,'07 and '08. I hope its enough. I believe in the other post that said insurance isnt looking for a 5 year weight loss, but 5 years of being MO. Very best of luck to you ! Keep us posted !       Amy

I would also have the dr's u have been seeing regularly write you a leter stating how long you have struggled with trying to lose and maintain  a weigh loss. I have BC/BS of Iowa and I got that before I even started any thing else. I hung on to it for like 9 months before I fully made up my mind to go forward for WLS. I knew I needed help when I started to gain and was dieting! So now I am 80 pound less and I feel great. I get tired more then before but that is because I am up and on the go more then ever. I like being able to get up and move pain free. I have gave up soaps because I hate to sit still now! Good luck you have gotten a lot of good advise here just filter through and see what will help U. Karen