BCBS decline

I have bcbs of IL though I live in Michigan.  I called today and they declined me per not having enough information.  They want 5 years of proof obesity, which found in 2002 my BMI was 33 not 35.  They wanted 6 months Doctor visits about weight loss and dieting, which I did 12. They said there was not enough detail history for this. What else can I do? I dont know where to go from here. The office I am working with never had to deal with BCBS of IL and is unsure what step to take next. Any suggestions? I never had to deal with a insurance company very so dont know how to handle this.   Thanks for any help

BCBS of IL is very reasonable on appeal.  Did you have co-morbidities when you were at the 33 bmi?  if so, that helps greatly.  Make sure they received all of your diet records not just a summary.

Hi there.  I too have BCBS Illinois, and I live in South Carolina.  But, hubby (it's his ins) works in North Carolina and my surgeon is in North Carolina. Gary, what state's law governs in these instances?  Thanks! Robin

Robin, you're looking at most likely BCBS of IL controlling since that seems to be where the plan is based out of.

I too have BCB S of IL and live in Indiana.  I began my journey April 26, 2006.  My 6 month diet has turned into 11 1/2 months.  I would submit and they would deny.  FINALLY I think I have things put together the way they want it.  (I hope)  It has been a lot of work and a long time coming, but I am going to resumit today.  Feel free to contact me and I would be more than happy to share with you what information I have obtained and what I have been through and hopefully this will cut your time down and you can whirl right through it. Vickie

Can you tell me exactly what you needed to make them happy.    I have BCBS of IL and live in Mississippi. I am in the process of my 6 month diet (last appt is July18th). Susan

I will be happy to, once I figure it out. lol  I have another request going in this week.  I HOPE this will finally be it.  Right now, all I can say is the more your doctor puts in his/her notes the better.  They kept telling me that the doctor wasn't giving enough information.  From what I can tell, they want to know exactly what you discussed at your visit, what suggestions were given to you, finally, I typed up a summary of each and every visit and my doctor signed off on them.  Most all of the summaries were 2 pages long.  I put what we discussed concerning diet, exercise, behavior modifications etc.  I am sending these summaries along with the actual office visit notes to them and crossing my fingers this will satisfy them.  If you would like, I can email a sample of what I am sending. Good luck and stay in touch! Vickie

that would be great...  [email protected] GOOD LUCK... I hope they approve you and you get a date ASAP