BCBS of IL?!?!?!?!

I currently have BCBS of IL coverage (I've actually had it for 10 years - and like them for everything else but this).  I took all the required steps, but I was denied.  They said that I didn't show that I exercised enough during the 6 month diet period.  I tried to work with them via a patient advocate and appeals but to no avail.  I figured that during annual enrollment at my job, I would dump them and go to something else, I have the option of doing an Aetna Healthfund - which is a high-deductible HSA. I checked and I  fit all the requirements for WLS , but they are a 1500 ded right up front, then 90/10 until the next 1000 and then they pay 100% - meds are going to be 50% (meds would cost me approx 2K a year - these are meds I would have to take weight loss or not).    I also have the option of UHC - but their website is kind of sucky and I can't really tell if my doctors are in their network and/or what their policy on WLS is. Here are the questions.

1.  Neither me, my doctor or the patient advocate were sure how to document a medically supervised commercial program so that I fit all the criteria for the 6 month clause.  Does anyone have any suggestions I can take to my doctor? 

2.  Has anyone ever been approved on BCBS of IL?  Because financially speaking - for me - it would appear they are the best health-care option I have at my employer.
 
AE starts on 11/19 - so any suggestions would be greatly appreciated.

I also have this insurance, and am having the same trouble.  I haven't had any luck with anyone being able to tell me what to do.  I am going next week for my 7 th month visit to my pcp. I'm affraid we are trying a losing battle.  If you have any luck at getting someone to give you advice let me know.  I also have two co-workers that are trying to get lap band and we all three have gotten the same letter from the insurance company and we are not seeing the same pcp, so I know that they are just sending this out to anyone that files.  Let me know if you come up with anything.

Pugsley

I also have coverage through BCBS of IL (PPO). I am currently on month 4 of my 6 month supervised diet. When I began the diet, a former OH member sent me a template of what he had his doctor fill out each month. (He was successful in getting approved for surgery - I don't believe he had BCBS of IL though.) I found the template to be very thorough and so I have utilized it the last 4 months. I would be happy to pass it on to anyone who is interested. Send me a private message with your email & I'd be happy to forward it to you.

-S

I have BCBSIL and had surgery in September. I started my supervised wl with my pcp in April and visited in April, May, June, July, August, September. We sent in my paperwork after my August appointment (planning that I would be denied for needing one or two more months) and that was the case, so I went in Sept, we sent in the additional month's notes and I had an approval within a week, surgery a week later. My Dr's notes consisted of documenting my weight change, discussed counseling, behavior modification, exercise, etc. They were basically just my Dr's thoughts about how I was doing and what she was telling me to do to continue with my weightloss. I lost about 20 or so lbs during my 6 months and always had a loss, even if it was just two lbs per month. I called often when my application was at the insurance company. I also think that perhaps part of my success was submitting my application one month prior to officially being done with my 6 months diet plan.... with BCBSIL they are one of the few ins companies that allow you to add info, without having to go through the appeals process (so my Dr's office tells me...which it did work for me). Not sure if all this will help, I have also been told that I was one of the lucky ones, so who knows.... I wish you all the best of luck and if you have any questions, please let me know. I can try to dig up a copy of my Dr's notes if you think that might help you. Good luck!!!!!

Amy

Thank everyone for their comments, due to benefits of BCBS of IL - I'm going to stay with them and follow all the advice given here.  I'm so glad that my doctor recommended this site to me...it's definitely been something that has helped me a lot.