Heard back from BCBS

For all of you wonderful friends that sent up a prayer for me when I asked last month, Thank You. Unfortunately, BCBS of IL sent back this response: "Bariatric Surgery would not be eligible under your health care plan because No medical documentation of 12 consecutive months of successful nonsurgical weight management....." EXCUUUUSE ME!!!! If I was SUCCESSFUL, I would not need surgery!!! Never fear...the appeal letter is almost ready to be mailed. I'll keep you all posted on my progress, and thanks again for all of you support! Dawn

Dawn, Even if you have to jump thru the hoops for the insurance, it will be worth the effort in the end. Good luck on your journey. Ricki

I had the same ridiculous hoops to jump through with them. Ironically, when I first started the process, they didn't have that rule. Luckily for me, I had other insurance to pick from with my company so I switched and I don't know how easy is it to appeal with BCBS of IL. But for your sake, I hope they approve it! Good Luck!

Are you sure they aren't suggesting supervised with a doctor for 12 months. That way you would have documentation? Just a thought

The appeal letter will not help unless you have done the 12 month diet. Unfortunately most insurance companies will not consider surgery unless you have done either a 6 month or 12 month diet. If someone is serious about the lifetime change, then going through the hoops of the insurance companies that WILL cover the surgery under their conditions. Please read your policy carefully. Cindy

Hi Dawn, I had BCBS also, and I battled with them for quite a while before I was finally approved. What finally did it was copies of every appointment I had over the last year with my primary, discussing my "supervised" weight loss program. I also gave them copies of all my WW meeting records. Are you sure you read that right? "Successful? weight management." Sounds like someone meant to type "unsuccessful".... Whatever you do, if you want this surgery, DON'T GIVE UP!! I don't want to discourage you and tell you how long it took me to finally get approved because some people can get approved in as little as two weeks. But BCBS was a battle for me. But I won! And you will too, as long as you are persistant. My surgery is April 24th - and now my battle for approval seems like a distant memory. Andie (Everest)

Dear Andie: Congratulations on your approval! I will send up a prayer for an uneventful surgery and a quick recovery, your day is fast approaching! I think that it is a typo, and that they meant to say "unsuccessful" and I attacked that first in my appeal. When I called to check on my appeal, (filed 3-24-06), the woman started reading me their denial letter from 3-30-06--it was the exact same denial that I had already received, except for the word was changed to "unsuccessful". I told her that it didn't sound like they had even read my appeal, and she put me on hold, then came back and said to disregard everything she had said, and to also disregard the letter from 3-30-06 when it arrived in the mail. They are still looking at my appeal. In it, I showed them 3 pages of medical studies that show that more dieting will not help, and now that Medicare does not have that requirement, I find it unenforceable and a delaying tactic. We'll see.......if they deny me again, I have 5 of 12 months down, but my pcp will argue with them that it is contraindicated for me to continue to wait. Again.....good luck and god speed to you. Let me know how everything goes. Dawn