Help!!! Can't find out anything from insurance co.!

I have BCBS of Illinois. They require BMI of 40 or 35 w/co-morbidities and a 6 month dr supervised diet(does NOT say consecutive months), nutritional therapy, behavior modification, physical activity, documentation of willingness to comply w/pre and post operative plans, and physiological evaluation. I have fluctuated all of my life. I have records of dr visits for weight control since 1994; however, none are continuous. (I usually went for 2 months and quit.) I am on my 2nd month of dr supervised visits with pcp. She is recording everything my ins requires. Since my paperwork was submitted,  I have called them at least once a day for the past 2 weeks to find out information about my approval. At first, my surgeon's office didn't send in my med. records. They only sent in letter of med. necessity. Once records were received, they stated that they didn't have enough info...my surgeon's office only sent in 12 pages total of my med records. The wonderful lady who I spoke with said it looked to be sufficient to her, so she sent all of it back to medical review board. This was last week. She was supposed to call me back and tell me what exactly it was that they needed more information about. She hasn't. I don't know if they never called her back or she forgot!?! Well, I called again on Friday and another wonderful lady said the same. She actually called the nurse, but got no answer, so she e-mailed her. She said she would call me back and it might take a couple of days. Well, I just got a call from her and she told me what all I needed to submit: med. record documentation of 5 yr history of morbid obesity, 6 month DETAILED documentation of clinically-supervised diet, nutritional therapy, behavior modification, physical activity, documentation of willingness to comply w/pre and post operative plans and physiological evaluation. What she sent to me is exactly what is stated in my ins. plan. So...what she's saying is that all of what I submitted is NOTHING!!! I don't understand. Did they not even look at my records? Do I need to organize it all myself? If anyone can help with how to organize my records to get approved, please HELP! Gary Viscio advises to appeal even if you're still completing  the 6 month diet, so I want to do all that I can to be approved. The insurance co. actually didn't deny me, as far as I know. I think they're waiting for me to send in the info before they deny me. I have many, many questions: Question 1: Do I need to get copies of my records and highlight details supporting information needed and send(they advise you NOT to fax) them in myself? Question 2: Do I need to write letter to insurance company explaining all information so they will see it as I do? Question 3: Does anyone have sample of what needs to go into letter? Question 4: My surgeon's office doesn't schedule anyone for psych eval until after approved, so what do I do? Do I schedule visit myself? If so, how do I know who to choose? Question 5: My pcp has been writing down all she can think of every month, but I don't know if it's enough to be considerd nutritional therapy and physical activity. How do I know it will be enough? Sorry about all of the questions. I just want to be thorough!!! Thank you very much! Also, if I've forgotten anything, feel free to give advice! Karen

My first question to you is... isnt youre surgeons office taking care of all of this for you, because they should be you shouldnt have all these questions and in fact it's even in there contract with the insurance company that they are supposed to do all of this for you including caling you're insurance company getting all the documentation together, you're insurance company to some extent doesnt really expect you to know alot about you're insurance when it comes to stuff like this which is why it is always part of there contract that if they are in network they need to get procedures pre-certified  FOR you... As for the nutritional therapy you need to contact you're surgeons office and find out if it has to be with a nutritionist or if you're pcp is good enough because i have seen people who went thru 6 months with there pcp only to find out it had to be with a nutritionist... most hospitals that have large enough bariatric surgery departments have a program set up where the dietician meets with everyone at once 1 night a month and you just have to sign in usually they will weigh you and then have a meeting. You need to ask you're surgeons office or if they wont give you someone call the local mental health center and ask if there is anyone there who could do a pre-operative evaluation for wls or if they can refer you to someon. Usually the part where the insurance company wants to see that you are willing to comply with pre-op post-op and will show behavior modification that is what the psych test is for. I dont want to frustrate you even more but from the sounds of it i would choose another hospital if available well it's still early in the proccess they dont sounds very supportive they should be walking you thru all of this.  Oh one last thing if you do end up submitting all of this yourself i would get it all together make copies and send everything in at once... Well i hope that was a little helpful.. goodluck!

You'll need the psych exam before so if they do it the other way around they're doing it wrong.  The insurance companies want to see clearance first, not after approval,  They won't approve it otherwise. For diet notes you'll need the monthly weigh in dates, weigt and that you discussed your diet and exercise and that you're complying. Your doc may not have submitted all of the records. If you send them, organize them and outline the contents as a cover sheet.