Insurance Help

This is my first post. After much sould searching I made the decision to go ahead with WLS. I went to a seminar and have a consult schedued for Monday afternoon. Now the hard part. I am told that my insurance BCBS will not approve unless I go through a 12 month medically supervised diet. Has anyone run into this? Is there anyway around it? My BMI is 47 and I have lots of comorbidities. Thanks in advance for your help.

Ronna- I do not have BC/BS but from everything I have read on here, no you there is not any way around it. Get to the doctor, start the process, get to the dietician anyone else you need to work with. Start it all NOW and then by the time you have your consult and the surgeon is ready for you the 12 months will be done!! I had to do six months for my insurance, let me tell you, the time flew by. I am having my surgery on Monday. Good luck, Nancy

I just wanted to drop in and wish you good luck on Monday. I will make sure I say a prayer for you and the whole team you will be with. I hope everything goes as well for you as it did for me. Shelley

Thank you Shelley I am encouraged when I read how well you are doing. Congrats Nancy

Thanks for the encouragement Nancy and good luck on Monday! I'll be thinking of you .

Ronna check out this post on BCBS - it goes into detail about what the 12 month supervised diet means and it does not appear Anyone has had any luck getting around it! Good luck http://www.obesityhelp.com/morbidobesity/state-forums/IL/postdetail/22776.html?vc=0

Thanks. I was hoping for a different answer, but what can you do?

If you have already verified that your specific policy will cover WLS, the best advise I can offer is what was posted above - start now!! Make sure you get a copy of the criteria that BC/BS IL PPO uses to make a determination and follow what's in there. Also, check it often to make sure that there are no changes (and surprise for you down the road). I did the 12 months and it flew by fast. Make sure all of your efforts are documented (with the paperwork to prove you did it). Also, make sure that you have medical records showing that you have been MO for 5 years. I submitted for approval, but am really having to work hard to keep things moving. I'll post when I finally get an answer. Wishing you all the best and good luck, San

Good Luck...I hope you are one of the lucky ones! I did the 12 months, had sufficient documentation, was denied, then appealed again with legal assistance and was denied due to "lack of nutritional Support"- this was explained to me as not being on Optifast or Medifast...which I had a letter from PCP saying he did not recommend that. I am switching insurance at the end of August and so I am no longer fighting with BCBS/IL. They have been frustrating and heartbreaking to deal with to say the very least. Everything in their criteria is vague and when you ask the customer service people you get different answers each time. I am now thinking it is just not my time to have this surgery....hopefully I can get it approved with the new insurance. I will send good thoughts your way however, because there are people with this insurance who get approved. I haven't figured out what BCBS is doing, but I hope you are one of the lucky ones. Cindy