Approved!

So, after a long hard battle with BCBSIL PPO (9 months to be exact) and two previous denials, I finally got approved after I took control over my process. They approved me in 1 day after recieving 260 pages worth of documentation and one long nasty 9 page letter telling them that they are violating their medical policy. For the longest, the medical staff at the University of Chicago has been telling me to read the medical policy and so I finally read the entire WLS medical policy and used the sources in their lit. review against them to prove my case. AHAHA! They didnt have a choice with all of the evidence that I met their requirements of a 3 month diet and that I didnt have to do Medifast, Optifast, Weigh****chers, Jenny Craig, etc. 

The most important things that I've learned from this appeal process
(1) DO NOT GIVE UP AND GO AWAY WITH DENIALS - denials means your missing information and you should harass as many people neccessary until questions are answered. (2)  USE THE INSURANCE MEDICAL POLICY TO PROVE YOUR CASE - read everything and research everthing.
(3) BE YOUR OWN ADOVCATE - stay on top of things, stay on top of people, make sure your information is correct, make sure it is recieved/sent and just triple check everything.

If anyone else has BCBS and need help with appeals, I can assist. In fact, I'll send you my 9 page letter if need be. Its way toooooo long to post on here. LOL.

Congratulations!!!!!

Congrats to you!

I am in fact going through this same denial process with BCBS of Illinois. I have been to the doctor since September and I get denied every time. The last denial I got I called and asked what exactly me and my doc needed to write down. My doc wrote everything they asked which was very detailed and just got my denial once again. I am so frustrated and will be calling them again tonite. If you have any letters or information that would help me in my case I would truly appreciate it. My email is [email protected]. Thanks!!

On December 15, 2010 at 2:15 PM Pacific Time, Saintsfan1 wrote:

"... just got my denial once again ..."

Amazing.  That's my same story.  BCBS/IL.  Deny, deny, deny.  We asked them EXACTLY what they needed to see, and it was information the doctor had ALREADY sent them.  I said, "Look at page 17."  They said, "We''ve denied the claim, and we're not looking at it anymore."  I tried to explain that they denied it saying there wasn't documentation that clearly existed.  It was like talking to a brick wall.

I found an advocate within the system (through my employer ) who wouldn't give up, and they FINALLY approved it. 

I wish you the best of luck w/ your battle w/ BC/BS IL.  They've been great about ever medical need I've ever had, except for this surgery.  But, in the end, they finally came through.  I'll be having surgery in 6 days.

Sorry for your struggle. Keep the faith.

Jonathan

Congratulations!!!