BXBS of IL

I am generally on the California board, but wanted to ask for feedback from the Illinois peeps.  My husband work for an IL based company so we have BXBS of IL.  I have been pursuing WLS for past few years and have been denied 3 times within the past year.  They require 6 months of supervised diet, exercise and behavior modification.  I have seen my MD monthly for the past 18 months and have provided these medical records and have still be denied.  How they can even think that a 300 lbs , 50 yr old mother of a five yr old kindergartener  would pursue or have the time to pursue WLS if it wasn't medically necessary!

Enough ranting--sorry--what I would like to know is if any of you have successfully challenged BXBS of IL and what language/wording could best support my case. Is the IL insurance commissioner helpful? I have contacted a lawyer but want to make sure I have explored my options.

Any feedback would be greatly appreciated.  

Thanks,

Hey good news you need to look up Ginawins blog.  She has a sample letter that she used to change BCBS decision and approve her for surgery.  My friend Stephiejo did this as well as was approved within a week.  Just be proactive.  IM either one of these girls and I am sure that they would be happy to send you a copy of their letter.

 Thanks for the info.  I have posted to both of their sites.  I'll let you know how things turn out.

So how small is Streator?.  I have a friend who left there, probably 50 yrs ago and she describes it as very small!

I know from reading posts of others from California, they have some insurance laws regarding WLS.  Do these not pertain to your insurance due to your husbands employer  being out of state?  I would check with the Insurance commissioner in California as the insurance company also has to abid by the laws of the states they provide coverage in.

 Thanks for the info.  I had been told that IL company has to follow IL law--but I have not asked the Calif insurance commission.    California law does not require 6 mos of supervised diet, etc.... and this indeed has been the hang up. Thanks for the suggestion.

Cristi

Streator is about 16000 peeps.  It isn't like you know every single person, but it is likely that you have someone in common with everyone.  I hope that gina and stephiejoe are able to help you!!

Hi! I sent you a copy of my letter I wrote. It worked. It took it out of BCBS's hands and into an outside Doctor's hands. The doctor was the one *****viewed it and approved it. I think with a few modifications, my letter would work for you. It sounds like you are getting the same runaround I was getting. Good luck!