? on BCBS IL 6 Months of Diets

I have BCBS of IL. I am confused about the six months of supervised diets. The policy does not state that it has to be consecutive. I called BCBS and asked them and the rep told me it did NOT need to be 6 consecutive months. It simply states 6 months within a 24 month period. I meet with my surgeon today and spoke with the insurance coordinator at the center. She told me that it had it said in the policy consecutive. I told her no it does not. She seemed certain to show me up and prove me wrong BUT when she pulled it out she was like you are right it does say consecutive months. I was wondering if anyone had any experience with getting approved withot the diets being consecutive. I have 3 months consecutive then 3 months off and 3 months on then 2 months off...2 months on. Losing weight..gaining it back. What are my chances of approval?

 I have been denied by BXBS of IL twice and am pursuing the appeal process.  I am unsure what they want !  I think I have met it and I still get denied.  Go figure.  Related to consecutive 6 months--my policy states "for at least 6 months, occurring within the 24 mos prior" to surgery.  It does not say consecutive.  I have been seeing my MD almost monthly-with BXBS paying for my visits and my meds.  I have been working with one of their personal health managers and I still have not been approved.  I know approval is a battle I can win--but keep in mind it may be an uphill journey.

An attorney I contacted to possibly help in my appeal, said that BXBS of IL is known to be difficult.

Good luck.  Read your policy. Know that you are worth it.

Thanks for the words of encouragement. It is a shame its so difficult to get help. If we were addicted to alcohol or drugs or even sex we could get help no problem.  People just don't understand how it feels to battle with weight. Good luck on your appeal as well.

I have BCBS of Tx. Before I ever did any research on this type of surgery I call BCBS to see if it was covered. The lady was nice and walked me through their website to print out the requirements. I've had occasions, twice, to call to ask about a specific point and each time I'm told something different by different people. On that list it specifically states that a commercial diet plan, such as Weigh****chers or Jenny Craig, could be counted in that 6 mo diet if it's within the last 24 mo., but then this person on the phone tells me it has to be supervised by a Dr. I called my Dr's office, the Dr *****commended the surgery and the surgeon to do it, and his staff tells me they've never been asked to supervise diets. So I'll have to drive an hour into Houston to go to the WL Clinic put on by my surgeon and pay $$$ for the privilege of their own diet! That will probably be better for me in the long run but it could be so much easier!

If it wasn't for that 60 requirement I could have hustled and gotten my surgery before the end of the year and had them pay for it 100% because all out of pocket expenses have been met. As it is, it'll cost me next year......that's ASS-U-ME-ing the policy doesn't change the first of the year!

I have BCBS of MN.  My policy also doesn't specify 6 consequtive months and the CS people I have talked to have also said that.  However, the insurance coordinator at my WLS office says that it should be 6 consequtive months, so I am now on my 4th month.  It does go fast.

Oh, and my policy also doesn't say I have to be seen by a dr. 6 times - the CS person suggested "beginning, middle and end".  Ins lady at my clinic rolled her eyes, and said "just go 6 times - I would hate for you to get denied over something like that".

good luck - you could try to submit based on what you have done since it technically meets the guidelines.  Doesn't hurt to try!

That is what I told the insurance coordinator but she acted so unconcerned.