Need more clinicals...(BCBSIL)

I have blue cross blue shield of illionois.  I looked up the requirments and meet all requirments.  I have a BMI of 52, not to mention I am diabetic.  I did the 6 month diet through WW.  All in all, I lost 24 lbs in a 6 months period.  There were gains at periiods. A couple of pounds, but would lose it and have an overall positive loss.  I have had the psych eval.  And I sent in the 5 year history.  Here is the thing.  I have been with my current PCP for a year now.  I was able to get their records.  But my last PCP, their scale only went up to 350lbs and I wiegh more then that.  So I asked the to write me a letter stating this for the dates of 01-03 to present. I do not know what they sent my surgeons office but it must have been sufficent for her.  I think that covers all the requirments.  I talked to my surgeons office and she got a message from my ins copmany saying they needed my clinicals.  What is that?  Why couldn't they tell me what they needed up front.

I think shey mean thy wnat the medcail reports from the visits you had. they can send the paper that has you ht and weight and bp and stuff like that. if you weighed 350 that should be fine. they only need 5 notes. remember 1 note from each of the five yrs. i have bcbs/il too ! to pm me if u need more help

Well the old Doctors, i wiegh more then 350 and their scale only weighed to 350.  So that is why I had them write the letter.  But come to find out that was not the problem.  After posting I researched more.  And I did not have "doctor supervised" program.  I just did strait Weigh****chers on my own.  So I started freaking that was the problem.  I thought I would have to go through the 6 months battle all over agian.  But nope, that was not the problem.  I guess the WW had to do with it, but they just wanted a letter of a nutional consult.  On the plus side, this was not a problem.  I was just diagnosed diabetic back in Feb.My doctor is having me go to a diabetis managment program of 4 classes.  I have completed the nutrional consultation part.  I mention to my nutritionist I was wanting to go for this.  She had told me if I needed something from them, she would write it up.  So i contacted her today and she said she will have it faxed to my Surgeons office by thursday morning.  WHEW.  And the insurance wanted more informtion on their program.  So once that is received they will be sending it to the review board.  Thank you for your offer to help, and if I need it I will PM you!

I agree, and that is what I ended up fearing last night after researching.  So for that is not the case.  Read my reply above!

I will be really suprised if you get the approval without a 6 month diet from a doc. I will be super exited for you and cannot wait to hear. I have had BCBSIL deny our patients because they go to our nutritionist for the 6 months! We actually have classes by a nutritionist and doc that do a lot more education that a 5 minute weigh in with a primary care doc. We had to appeal several cases and finally won, but it was time consuming. I wish you the best of luck. Let us know when you hear! Bonnie