BCBSIL approval

I have had a real struggle with BCBSIL, trying to get approval for the RNY. I was first denied because I did not have a diet and exercise plan, althoug the request was sent in by my nutritionist, with a very thorough diet and exercise plan mapped out and documented.  I resubmitted.  I was denied because I did not have weights documented for the past five years- I RESUBMITTED the weight history that  was already in my file.  Then I was denied because I did not have a thyroid work-up.  I RESUBMITTED the one that was already in my file.  I was denied because I did not have a surgeon's eval.  I RESUBMITTED the surgeon's notes that were already in my file.  Then my husband submitted his request, based on my experiences-A very thourough chart, I might add.  Guess what?  He was denied on basis of not having a diet and exercise plan.  (The nutritionist had been very careful to document his 6 months well, as well as his very strenuous workout schedule.)  Finally, I looked up the insurance commission for Ill. on the internet.  I filed a complaint.  It was just a form on the net where I put my insurance information, and my problem with them.  That was Monday.  Today, on Thursday, my husband and I have been approved for the RNY!!! YEA!  It seems as if more people would file complaints with the insurance commision, there would be less problems for us who are needing this surgery so badly!  Just a little tip for all of you out there who are struggling!

 

That's FABULOUS! Congratulations!  Please stay on the insurance forum so you can spread your experience and wisdom to others who are fighting these battles.  It seems like you have much to offer to others fighting for approval.

That's GREAT! I was denied for not having 5 yr history. i made a plea for help on the main board.

That's the way to show 'em. They clearly have a list of things to claim to tell you they didn't receive. LIARS! Good for you. Bet you they were shocked. It's too bad people don't know about the state insurance commissions. Thanks for sharing & good luck to you both. Kahlua