DENIED by BCBS of IL (PPO) HELP!!!

DENIED...Now What? Well, it is official. I have been denied by BCBS of IL (PPO). Big Surprise, huh? I am at a loss as to what on Earth I am going to do now. My surgeon's office says that I can appeal, but the reason is that I don't have a full 12 months of medically supervised diets. (although I do have over 8 months) She says BCBS will not budge on this issue and that I should go back to my PCP and do a full 12 months and try again. I do NOT want to wait that long!! Besides that, I have had two other surgeries this year, so I have already paid my deductibles and it would be much cheaper for me to have it done this year. There may be light at the end of the tunnel, though, because my husbands work is looking into changing their insurance. Which could be better.....or worse.....does anyone know anything about Unicare?? I am getting so discouraged!! meanwhile, here I am at my heaviest weight EVER...with aching feet and legs and feeling so miserable and like there is no hope for me. I knew it was going to be too good to be true for me. Either I would have the surgery and be the one person who fails with it....or couldn't even get it at all. Gilly

If you have over 8 months of supervised diet, then go to your PCP and do the other 3 months or so that you need...then appeal. I would definately do that, because most insurance's now, require 12 months supervised diets. DON'T GIVE UP!!!! Tricia

Don't give up!!!! I know you WANT surgery right now but insurance wants 12 months supervised dietician. OK, so what?! What is the harm in it? It will be good for you and who knows...after 12 months you might not even NEED surgery!!!! You do what you have to do but don't give up hope. If they will pay for it...do it. If they won't pay for it....I think they are being pretty silly about wanting it then. You do your appeal. You do what you have to do. I know about the aching everything. It totally sucks. But if you really want this...you're gonna have to fight for it! YOU CAN DO IT! HUGS Melissa Lap RNY 8/31/04 391/358/190

Thanks for the info and the support. You guys are great. Gilly

That is odd that they denied like that. I was approved within 2 weeks of the letter. My problem was the clinic stopped taking bcbs of IL (PPO) when I was approved. Now I'm trying through Medicaid. They didn't require me 12 months of supervised diet!! Maybe cuz of my BMI and co-morbities??? Good Luck, and Blessings, katie

Gilly, There are quite a few people I have run into on this forum with the same insurance issues(including myself). I got all the information together and was told that the clinic would not even SUBMIT because they knew BC/BS needs 12 months within the last 24 months. By the way...you can look on the web for the specifics of what they want for your approval to go through. If you go to the BC/BS page, click providers at the top, then search for morbid obesity, you will see in black and white exactly what they're looking for. As for me, I'm off on Wed this week to start my 12 month diet. I also have an appt scheduled with Dr Frantzides on Friday...his nurse seems to think there might be something they can do to get around the diet portion of the requirements...I'm not counting on it...I have to diet and exercise whether I have the surgery or not. I wish you the best, and hope you have better luck with Unicare. Please e-mail me if you need the BC/BS requirements, I can e-mail them to you if you like. I didn't post them here as they're sort of lengthy. Anne

Please email them to me because I could not find them. Thanks

Anne, I also have been denied by BC/BS. After you see the Dr. let me know if there is a way around it. I have been waiting for about a year to get aproved. Help ! Cheryl

Don't you just hate that company same thing happened to me but I got around it and i'm having it somewhere else with dr. Frantzides of Evanston NorthWestern good luck to you

Gilly, I am sorry to hear this. ..I have bcbs of Illinois, and I was approved right away. The most of my problems were with BTC Fairview Insurance. I got approved a few weeks ago, but yet I did not have 12months of dieting. I think it was due to my weight...I am like 353lbs....but yet at the present time I have no diabetes, borderline high blood. As I told Anne K...I think I just slipped through the cracks.