if anyone has BCBS of Illinois and has been denied, please read!!!!!
Hi, Everyone. I work for a New Hampshire company that has BCBS of Illinois due to our Corporate office being located in Illinois. I have been denied and my appeal has been denied three times. I am currently seeking congressional and legal help. I would like to form an alliance team with anyone who has been denied. Please email me at [email protected]. My plan is to go public and to do this, I need back up. I have provided BCBS of Illinois everything that they have requested and they still deny me. Their letters are contradicting of one another and the employees at BCBS of Illinois also contradict one another. My NH congressman Jeb Bradley is currently sending my info to the congressional bcbs liason. BCBS of Illinois is known for it's Fraud...look it up on google. They have the biggest fines from the Federal government due to Medicare Fraud...144 Million...no wonder why they won't approve any of us. If you have been approved and had to go through H*** and High Water to do so...please also let me know. Together we can make a stand. Thanks!
Karen
I was denide from bcbs of Illinois after they sent me an approval letter saying the hospital stay was a medical nessasty.
We went public thanks to my wife we were on nbc news and the chicago tribune. I think the story is still on the nbc website its nbc5.com go to search and put in blue cross.
I wound up geting the surgery coverd under Humana.
But we are not done with them yet.
You can e mail us direct and we could talk.
Jeff
Karen,
I think it depends on what procedure you're seeking. For instance, I have BCBS MN, and I was trying to get the Lap Band. They denied me, but I know BCBS IL just signed an agreement with Inamed along with a few other states to cover the procedure.
You might want to contact Walter Lindstrom, he's handled a large number of discrimination cases and fought insurance denials for wls. He's a former patient himself, so there's a great deal of sensitivity to the issue. You can contact him at the website below:
http://www.obesitylaw.com/
You can find others like yourself on the Spotlighthealth.com website. They have an insurance discussion area and you may be able to dig up more dirt on your insurance company.
Lastly, don't forget the lists on Yahoogroups. You will find a number of people on there that can be of assistance. They often post successful appeal letters and have patient advocates that can handle the process for you. Be sure to check out the BandstersInsurance group. They have a wealth of knowledge. Search for local groups as well.
http://groups.yahoo.com/search?query=band+insurance&sc=-1&sg=10&ss=1
Please let me know if I can be of further assistance. I'll keep you in my prayers.
Gabby
Hi Karen,
I do not understand why one BCBS is so different than the other. I live in IL and when I told my surgeon and all my doctor's I had BCBS they said good luck, BCBS of IL will never approve this procedure they are the worst. When I told they I had BCBS of CA (corp is located in CA) they said well maybe they will be different.
Karen, I didn't have one problem. My surgeon provided them with a letter stating it was medically necessary and they faxed it to BCBS of CA on 7/1 and my approval letter was dated 7/2.
I am sorry for all your trouble. Good Luck!
Take care,
Kathy
6 days to go
Karen--I have BCBS/IL and am having RNY on 8/31/04--after winning my appeal. I first sought approval last Sept. My surgeon's office said we'd keep our fingers crossed, as BCBS/IL had made some much stricter requirements over the summer of '03. I did everything my surgeon's office manager said to do, filled everything out thoroughly, had risk factors, psych eval & letter, PCP letter, the whole 9 yards. Then, early in Oct. found out from BCBS/IL that I had to do the medically supervised diet for a minimum of 6 mo., incl. daily diet diaries, nutritional ed., exercise, behavior mod.--all this could be done thru my PCP. Well, I was disappointed but not overly shocked. So we played that game--monthly visits w/ my (very supportive) PCP, making sure I just bounced my weight around and didn't make significant progress. That ended in May of '04. Everything was re-submitted. Took about 3 wks. to get a denial. I almost fainted to find out the reason--they had changed their policy and now require a 12-mo. med.-superv. diet. Many phone calls later, they were still not budging, even tho they admitted that their phone records showed I'd been told 6 mo. They were sticking to their guns that requirements had changed. So I got the info. from them what to do about appealing. I wrote a personal letter, laying out in detail everything I'd been told & everything I had done done, IN GOOD FAITH. I ended it by saying I would pursue approval by litigation if necessary (altho I wasn't sure I would do that). I sent this to BCBS/IL, the IL Dept. of Ins., my surgeon, & my PCP. Within 10 days, I was approved (received letters from both BCBS/IL & Dept. of Ins.). I consider myself very fortunate, as I've heard horror story upon horror story about BCBS/IL--and from what I heard from my surgeon's office, they used to be one of the easiest insurance cos. to work w/.
Dear Karen:
I was denied by BCBS of Illinois this week. I am 300 pounds overweight, can barely walk, have breathing problems etc.,
They want seven more months of Dr. Supervised dieting.
Karen....in my heart, I don't have 7 more months. My quality of life is declining quickly.
What do you suggest?
Sincerely
Patricia Pickering
[email protected]
Hi Patricia,
I totally understand! I have BCBS of Illinos and they are unbelieveable. I have fought with them for over a year!!! I thought it was never going to happen and it happened today. Keep up the fight it is worth it. My surgery is scheduled for June 14 and I remember a year ago when I thought there was no way i could make it through another year and I did. I will pray for you!!!!!!
Meg
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