BCBS IL???

I have been trying to get BCBS of IL to approve me for wls for serveral months.  They use to have a 12 policy now they lowered it to 6 months.  I have sent in all my documentation and they denied stating not enough notes of nutrition therapy, diet, and exercise.  So, I got a detailed form that had a place for my doctor's notes and my notes.  I sent this in and they still denied not enough documentation.  Mind you I have well over 6 months with my doctor and all this includes me taking different prescribe diet pills each month.  So, I got my doctor to type up a letter for each month stating I was on a 2,000 calorie diet, pills, low cholesteral, and all types of exercise I was doing.  They still denied me for not enough documentaion of nutrition theray, diet, and exercise.  What is they deal is there something I am missing???  It would be wonderful for any type of help.  Thanks.

Hi Jamie: I have BCBS of Alabama and this is what I understand that they want.  They do not want a form or letter from the doctor.  What they want is an actual copy of your medical record.  They will not accept just a weigh-in document.  They want a detailed progress note from your doctor from every month (must be consecutive, meaning you can't have skipped a month) with documentation of your weight, diet plan and exercise plan included.  I also made sure that my doctor documented that I was concurrently seeing a nutritionist.  BSBC requires a nutrition consult (at least one, but I did several just to hedge my bets so to speak). 

I would get my doctor to do a progress note for each month including the above information.  My doctor also noted my co-morbidities (hypertension, pulmonary hypertension, arthritis, etc.) on the notes and mostly that I still had them.  Also, what BCBS likes to do is they tell you that you need a certain amount of time for the diet (mine was 6 months), but if you try to get approved after 6 exact months, they will deny you, saying that you really need 7 doctor visits, as the first one is a consult.  So...I started my diet in January, but instead of having my last visit in June, which was 6 months, I went for one last visit in July. I got copies of all my medical records from my PCP, psych consult (required by my surgeon) and nutritional consult notes and indexed it all and scanned a copy into my computer so I would have it for later if they tried to pull the "we didn't get the info" routine.  Then I would be able to just e-mail them the whole lot if necessary.  I took a hard copy of this packet and gave it to my surgeon, who in turn submitted it to BCBS.  I got appoved in 12 days after that. I know how frustrating this must be for you, but I think if you get an entire packet together and send it all at once, you will have a better chance of them not saying that something is missing.  Good luck!

I have sent in each month individually on a she of paper like doctor notes.  My doctor signed it and everything.  They are all back to back months.  Still they seem like they won't budge!

If you sent them all individualy, I'll make a bet that they don't have half of them.  You might want to try putting the whole thing together and resending. 

I have BCBS of IL and have had the same exact problems...read my post I just posted.