BCBSIL - Are you Suprised?

(deactivated member)
on 1/24/08 9:23 am - South Point, OH
I apologize in advance as this will likely be a long-ish post. In Jan 2006, I started Weigh****chers, and went til April 2007. Along the way I joined a gym, and have documentation of all my attendance records for each.  At that time I did not have any intention of having WLS, I was doing it to try again to lose weight and get healthy, etc. In Nov 07 I started researching WLS, and went through all my appts with psych, nut, etc.  On Dec 13, I was submitted for approval. After six weeks of faxing, re-faxing docs, they now have over 100 pages on me.  I meet the requirement for the BMI, the five year history, but I am stuck with the supervised weight loss. Because I did Weigh****chers on my own, with no intention of having surgery, I did not do it under my PCP's supervision.  He did however, recently write me a letter recommending me for WLS.   So even though I did well over the six months required, and show docs that I actively participated in  a recognized weight loss program, I am denied because my PCP did not supervise me or document my process. My question is this - Is it even worth fighting for?  I have an appeals letter ready to go, but since we only get one shot I don't want to blow it.  Should I just suck it up and go through the supervised six months?   I am at a loss and obviously discouraged.  Just wanted some opinions from those of you who have dealt with them before. Thanks so much in advance 
(deactivated member)
on 1/24/08 10:55 am, edited 1/24/08 10:57 am
Mslayd02 aka Mrs.
Big_Cle

on 2/2/08 6:18 am - Durham, NC
I just got approved thru BCBSIL this week and Ill just say if you dont have documented with you PCP that you were doing weigh****chers and working out they wont approve you. That was one of the things my surgeon emphasized. I had been doing weigh****chers for sometime myslef and seeing my PCP every 3 months and that wasnt even good enough. So my suggestion is go ahead and suck it up and do the 6 months diet plan. But on the brighter side after i did it my paper work was recieved on Monday and I got my approval on Thursday. Dotn get discouraged and dont give up.

 

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