BCBSIL PPO certain amount of lbs to lose

Hello does anyone out there have BCBSIL PPO and did you need to lose a certain amount of weight? My file is with the insurance company and they have everything. I followed all the criteria they have. The surgeons office says my file is still being reviewed but at this point is being denied because lack of substantial weight loss in the 6 month period. The insurance company says its because I don't have all 6 months done. I started April 3 and they sent in April 3 through Sept 17th. The office says that is 6 months BCBSIL says no its not, and thats the reason. Office says insurance is telling a fib, who do I believe? Especially when I talked  to 2 different people at the ins company that tell me the same thing.                         Renee

I also have BCBSILL PPO and I was required to lose 5% of my body weight, which I have and my 6 month period end on 10/3. And The Bariatric Center I am attending has or should be sending my file in soon.

Same insurance and same surgeon. They have never told me any such thing. BCBSIL doesnt even state that you had to lose. When I called they simply stated there needed to be an attempt for 6 months, supervised, etc. If you call insurance, they should be able to tell you what dates they have. The CSR I spoke with told me everything is scanned in so they should be able to see it.  have you received your letter from insurance yet? I know when the surgeon gets theirs yours should follow shortly.  I was denied b/c of the same thing not having 6 months when i do have 6 months. The rep said maybe they cant see the dates (the area where  the date is written is shaded, so when faxed its too dark). I had the BMI office give me what needed to be submitted so that I could make sure its all there and have my PCP add whatever was needed.  This would be a better experience if I would get some clarity on things. Be sure to inform us of what happens

Thanks Paul! I didnt think to add that 7th appt in. Hopefully this works. I will be sure to include that  this time. 

Thanks Paul I agree, I was told as long as I made it in once a month I would be fine. In July I made the appointment a week later since I was sick the day of my appointment. There was not a problem, and since I weighed in on the 17th of Sept, which was what they had open my appointment this month is on the 15th. It was the first day they had an opening. You would think someone who handles this daily would know. 

Thats the sad part it was.

Renee - your post gave me some hope today. I also have BCBSIL PPO and I just received a denai of coverage letter today. I was devastated. My letter said that I had not met the 6 month medically supervised diet, but I have been following the program that the bariatric program has recommended for me, including meeting with an APN, nutritionist and athletic trainer since April. Now I think my denial may be that I only completed 5 real months. I also started in April, and my last visit was in September. The APN and pre-certification person both told me that I needed to complete "6 visits in 6 months", which I did. But April to Sept is only really 5 months. Other than that, I can't think of any other reason for the denial, unless the documentation they submitted wasn't good enough. Guess I'll have to call the insurance company on Monday to find out exactly what happened.

If it's true that I just need to complete 1 more visit in October to complete the 6 months, does anyone know whether insurance will allow for another submission for approval? Or, since I was denied, do I automatically have to go through the appeal process? I've never had to appeal anything through the insurance before, so I'm nervous about going through this. But, I've worked too hard to give up now!!!

I know what you are going through.  I have BCBSIL EPO, and just received the second denial.  The first denial was because I didn't have 6 months of medically supervised diet.  I actually had a REALLY good 6 month plan with great documentation.  They just denied because  I think they start every case that way!  I was given the run-around for a month after I submitted the appeal.  Yesterday, I finally got an answer.  They said yes I did have the 6 month plan, but need a metabolic profile (I had one done at the beginning of my wt loss program, and I'm sure it is in the records).  They also tell me that my bmi has not been over 40 for 5 yrs.  It was just at 36 5 yrs ago, but now is 42.  They want me to have a bmi over 40 for 5 yrs.  I am SOOOOOOOOO frustrated.  I have pictures of me 5 yrs ago at the plastic surgeon's office, before a tummy tuck after I had lost 50 lbs. on my own.  Because I don't have that documented in a Dr.'s office, they won't consider it.  Whatever do I do now.  Any advice?