I have BCBS and I just wanted to tell my story..about my denial.

I knew back in Nov I wanted to get WLS.  At the time my company had a policy for all the employees.  I knew that I needed a 6 month supervised diet starting in Nov.  So I went to my PCP to start a diet plan.  Also went to see the surgeon in the same month.  What I didnt know was that I was supposed to go into my PCP once a month every single month.  And although i was still dieting and acutally lose some weight...I wasnt going into my PCP to get weighed every single month.  In about March my company decided to switch to Health America.  So I called up Health America to find out if there was an exculsion or what.  Here there was because we had under 100 people in the company.  So there was no way to even get the rider for it.  The owner of my company tried.  He said he would pay extra if he had to.  Anyways, I got to stay with Blue Cross & Blue Sheild.  I had an individual policy.  Lucky for me, the owner of my company decided that he would pay for Blue Cross for me.  (I guess working 84hrs a week every single week for the past 2 years helps) In the meantime I went to my PCP a few times.  My first attempt for insurance to cover my WLS I was denied.  Denied due to the nutrition consultation.  I didnt lie at all and told the lady exactly what I was eating.  Obviously I wasnt eating correctly thats how I got obese in the first place!  I took what the nutrionist said to heart and changed my ways so much that I had lost about 15lbs in 3 weeks!  I no longer drink regular pop!  So everytime I went to my PCP over the last year they wrote up a form to use for my supervised diet.  Turned out I only had 4.  I needed 6.  So I needed two more.  Well I went one month around the 25th.  Then I went on the 1st of the following month.  So it was only about a week.  But no place in Blue Cross policy does it say that it has to be atleast 30 days apart!  It just said different months!  I argued back and forth with the insurance lady my surgeons office.  She didnt want to submit to insurance because of fear that I would be denied again.  My caseworker from Blue Cross and Blue Shield was the one who told me to resubmit my paperwork and all would be well.  I had to write a letter to my surgeons office and tell them that I am the patient and I will take my chances of another denial.  Some advice I can give someone workin on an appeal or a denial.....just KEEP CALLING YOUR INSURANCE COMPANY IF THEY DENY YOU.  I CALLED EVERY SINGLE DAY FOR 2 WEEKS!  I was so depressed that my hair was falling out!  And trust me I let my insurance company know about it!  I asked the one rep on the phone why is it up to Blue Cross if I live or die?  My next step was hiring an attorney.  I was going to send them nekkid photos of me too.  That would have been enough to scare anyone!!!!  I also was going to write them a long letter on how it is to live like this.  I really wish that each one of them could walk around with 150lbs strapped to them.  I dont think anyone could say that it wasnt medically needed after that.  I just dont see how sometimes they can just appeal.  If your PCP says you need it and then a surgeon says you need it to!!!!  I am going to send them a thank you letter a few months from now.  I am going to thank them for making the choice to save my life!   I had to come back and edit! I almost forgot to say that I was APPROVED.  I got a call on Sept 12 saying I was approved and I will be having surgery on Sept 22nd!  Its all going soooo fast!  And I still feel like they are going to try to find some reason to revoke my approval! ahahahahaha  GOOD LUCK TO ANYONE DEALING WITH A DENIAL.  IF THERE IS ANYTHING I CAN DO FOR YOU LET ME KNOW! DONT GIVE UP!!!!!!!!!!!

I just need to know if it was Empire Blue Cross Blue Shield PPO?

Nope just their individual plan.  But reading your post encouraged me to tell my story of my experience with them. 

Thank you.