BCBSIL and getting approval - what's the secret???

look at your certificate (ins) that will give you details on what you have to have done prior to approval.

I'm sorry you're going through this. Stay tough and push for what you want!

I had BC/BS of Illinois and they approved me ONLY for RNY and Lap-Band with minimal fuss, but I ONLY wanted the DS and they ONLY wanted me to go the less expensive route. Shocker, right?

It just goes to show you that they will do anything they can to save a buck, even if it means giving the patient something they don't want. I'm surpised they'e not trying to just give you a baby aspirin and an Alli pill and make you go away! It's a hell of a lot cheaper for them.

Seriously, the insurance industry says that most people will switch insurances on average, every 18 months. I think they just hoped that I would take whichever surgery they were willing to pay for and wouldn't seek a revision on THEIR dime within those 18 months! That's the next insurance company's problem, right?

So I started fighting with them, but kept going to my PCP monthly to get weighed and "talk" about weight loss, nutrition, my aches and pains, etc., which she dutifully wote in my file. I went to a nutritionist, too and had her document my weight, food journals, etc. And then my hubby got a new job with new insurance that covered the DS, so I didn't need to fight BC/BS anymore. Now that's probably not an option for you right now, but it does pay to think about if you've got an open enrollment coming up or are fed up with your current job. But whatever you do, don't stop the monthly PCP or nutritionist visits for any reason, because they'll say you have to start over.

Get YOUR plan in writing from them. Don't get caught in the verbal game of he said/she said. Make copies of everything you send them, everything they send you and your doc. Fight the good fight to get the WLS that's right for you. Just stay cool. You'll eventually get what you want, even from those cheap *******s.

Woohoo Nicolle...look at you go girl!  108 lbs gone...keep  up the good work. : ) Paulette

Thanks, Paulette! You're doing great! It's almost August 5--are you at your 245 goal yet?

Nicolle

Hi Nicolle,
I was at 247 this morning, I'd love it to be 245 tomorrow but I doubt it, I've been having trouble this past week getting enough calories in... Better yesterday, today still @ 200 short..., couldn;t finish all my dinner, hopefully later.  Take care, Paulette

It took 18 months and 8 days to get approved byBCBS of IL-I have a POS from UPS.  WLS is covered but every time I fulfilled their criteria, they changed it.  I saw my endo for 11 months, because @ that time they wanted a 1yr supervised diet and then they changed it to 6 months.  His office records weren't enough -we had to fill out monthly froms for each visit and document everything I did for that month to lose weight.  If you miss 1 month-you start over.  My BMI was way over the needed number and I had enough co-morbids to share and I was denied more times than I can count-each time for another BS reason.  I kept at it w/the help of my surgeons office and had peer reviews and 3 appeals.  Finally when I got ticked enough I wrote channels2,5,7 and Oprah and told them about my run around.  11 days after I wrote the letters I was approved.  Also they require a psych eval-but in a lot of cases won't pay for it.  Mine was covered by Medicare so that helped.  Get everything in writing from BCBS and take names.  Doument everything and don't give up-that's what they want you to do.  I'll be praying for you-Hugs-janet K

Oh my Gosh Janet, you are a real trooper!!!  That seems like forever, and all of the emotional roller coasters you must have road!
I like your *****!!!  That's what I feel they are doing to me, this is my 2nd denial.  I am willing to do what they want I just want them to tell me what it is once and for all and stick to it.  If I do this than we will do this.  To me it is that simple, but they change the rules of the game.
What did your monthly forms consist of?
Can I pm you with my email address and maybe you could give me some more detail?  I appreciate all the help!
Jeni

I was approved after 24 hrs of submitting it to my insurance. I had Pacificare at the time. I have BCBS Fed ins now. Not sure what they would do If I was to have surgery now.
But when I tried to do my plastic surgery Lower Body Lift I had to fight Pacificare. I threatened a lawer on them and a law suite if they didnt pay for it. It is writtin in their ben book that they pay for surgery that results in another surgery to fix a problem EI loose skin. My lawer went to bat for me and they approved all of my plastics. I know BCBS wouldnt pay for cosmitic reconstruction for Weight Loss.
I think if you had a FEderal BCBS policy you wouldnt have to go thru all of the criteria for Weight Loss surgery.
I know it doesnt help!!!!! Carla 

Hi Janet, you & I have the same coverage, BCBSIL POS  through UPS!!   Paulette

Eddie was the senior dispatcher for UPS SCS(not Brown) in Bensenville until he got sick-now he's disabled retired so we have to deal w/the benefits people for the premiums and they are like talking to cyborgs.  What did Earl do?  The health plan is great but we don't like the mail order drug plan.  Sometimes our pills come opened and broken.  And hsi blod presure patches come in boxes and they look like they were dropped kicked!  Of course I squawk and they replace it, but it takes more time and aggravation.  I should quit $%$%itching and just be grateful we have it right-of course right!  Have a great day sweetie-Hugs-Janet