BCBS PPO Illinois

Hello all.........I have read some great things on this site and I was wandering if anyone has any advice for BCBS of Illinois PPO.  It is weird in the paperwork it says 6 monts supervised diet but 2 of my coworkers have had the same surgery and did not have to submit 6 monts worth? Do the rules bend that much?

I also have BCBS of IL and they are requesting 6 months diet.   My surgeons office said they are sticklers for that. I would love to see if other got around it. GOOD LUCK

I sent them doucumentation of a 12 month supervised diet and they still claim that I didn't have proof. I am working on an appeal right now. Good luck Mike

BC BS if Illinois was the worst, I get the insurance free from my husbands work and they denied me after an appeal, had all the info they required and was still denied, so i took out a policy at my work with Great West and paid for insurance and was approved within 24 hours.  Go figure.

I too have BCBS of Illinois PPO.  The hospital sent in for Pre-Certification and I received a letter saying it was not approved until I sent in further documentation.  My surgery was originally scheduled for 1/31/07.  I visited the provider portion of their website and obtained their criteria for documentation for WLS.  I submitted a letter from my Primary Care regarding 5-year documentation of morbid obesity, a letter from another doctor stating I had attended a nutrional counseling program for 9 months, a letter from the nutrionist with my weight loss charts and a letter from a Doctor from the medically supervised weight loss program within the bariatric surgery program I have been attending for over a year.  I was told that the nutrional program I attended wasn't enough.  I still was told it was not enough documentation...they wanted actual medical entries from my medical files.  Although I felt this was a great personal infringement, I did send them my medical file from the past 10 years and my medical file for the past year and a half from the Obesity Clinic.  I received another letter saying it wasn't enough documentation.  I called BCBS and asked how to appeal this decision.  The customer care person I spoke with realized that the second set of records had not yet been reviewed.  She sent those along.  This week I called again on Monday and they said it was still in review.  I called again today and she said it was still under review.  I am not sure if that is good news or bad news...but usually their letters of insufficent documentation were issued the same day of submittal.  I feel frantic.  Last year I was denied with Anthem because they didn't cover WLS.  I felt uplifted when my husband took a new job and I had another chance with BCBSIL.  Now I feel hopeless.  What I have found after working with them over the past month is that YOU are your best advocate at this point.  Read all their criteria and manage all documentation yourself.  I had all my medical records released to me so I could ensure that what they received was what they requested.  I also now have a packet of over 100 pages of documentation to use for an appeal if necessary.  I have a BMI of 42, sleep apenea and borderline hypertension...though I can pretty much assure them that I will need blood pressure meds by the time they finally give me an answer.  I keep watching people at the Clinic and they all are passing through insurance easily...Make sure you document as you go Half Pint!  Good luck and God bless! Jane