Waiting on approval bcbs Ill?????

Can anyone tell me HOW they got approval without the continuing denials. Twice I have been turned down and I must have 12 months surpervised weightloss program. I am sure my DR. as this but after I send this I keep thinking they will ask me to jump through another hoop. What to do? Cherry Lane

Cherry, I do not think that you are going to get around the 12 months of doctor supervised diet trys. My understanding is that BCBS IL is very strick on it now since I think the beginning of '05. You better check with them several times because I have heard of people needing to see a nutritionist also during that 12 month time in addition to the doctor also. I have also heard that they want each month on a seperate sheet of paper from the doctor describing what transpired with that month's visit. It is like the building adage, measure twice cut once. I have heard of people that get different answers to the same question with BCBS, so that is why I say to ask your question SEVERAL times as to what the requirements are to be approved. By the way I do believe that they want 12 months of CONTINUOUS diet trys, not 12 months total. Good luck.

Cherry, I got approval from BCBS on July 5th after one denial. It was extremely difficult to know what they wanted. Luckily, I am in a program through a hospital that keeps updating their requirements to fit with the various insurance companies. By the way, they say BCBS of IL is THE most difficult and uncooperative. I could get no information out of them as I couldn't get past a customer service rep. The bariatric coordinator was able to get through to the necessary people to find out what I really needed. In my case, they wanted me to try Optifast and diet pills, a 12 month formal exercise program and a 12 month behavior mod program. (I had completed a 6 week one). The coordinator had my PCP write another letter saying he didn't want me to have pills or optifast due to diabetes and no formal exercise program due to poor conditioning and severe arthritis. The coordinator went through the 12 mo. nutrition program and highlighted all the parts that dealt with behavior modification. I was accepted 30 days later. Keep in mind that I have a BMI over 60 and numerous comorbidities. Don't give up. It will come. Sherry

hI Sherry! Yes- I've heard the same from my surgeons office regarding BC/BS' policy. I am currently enrolled in a comprehensive program through my surgeon. I see a nutrionist every month, a PCP/dietician every month, every 3 months I see a personal trainer who puts together a 3 month workout program for me, and at the beginning and end of this program I see a psychologist. This is the "comprehensive" program that BC/BS is looking for. I was explaining in a different topic about why I feel BC/BS does this, or why I want to believe BC/BS does this rather. After the success of the surgery was advertised by movie stars and other high profile people, everyone who was overweight to morbidly obese wanted the surgery. They started with the blanket approvals then-the requirements were just to be so much overweight and have your doctor do a letter of recommendation for you. After the surge in patients asking for approval- and probably some who didn't truly need this, nor knew how to use it- started BC/BS tightened their rules for approval. They (and again this is MY HOPE!) wanted to protect their patients from having major surgery if they hadn't tried other methods before and if they did approve you they wanted you to stay successful with this tool for the rest of your life, not just the two years or so before your stomach can go back to the size it once was. I am enrolled, started in November 23, my 24th birthday and have 4 months to go until they can submit for my approval. I have lost nearly 27 pounds, and many inches on my body throughout. I've done this strictly through the new ways of eating that my nutrionist has taught me. I am NOT on a diet, I am making lifestyle changes that I would NOT have made without this program. Therefore, I am thankful to BC/BS (at the moment since I've not tried for approval yet..hehe) for this requirement because when I do get the surgery, I'll be ahead of the game with good choices, healthier eating habits and a stronger body for a speedier recovery. I look forward to my re-birthday, and I pray every night that when its finally my time(Again) to get the surgery, it will be an easy approval. I've been through a lot this year, and have been waiting a long time to live once again. Just work with your surgeon and PCP to develop a program as close to what they are looking for as possible, and then go from there. I wish you all the luck and success this world has to offer.. Peace and Blessings.. Meghan