BCBS of IL seems to be a problem!

I see several posts on the board where some of you are or have been strugggling with BCBS of Illinois. I have an ERISA plan through my employer... State Farm. I wish that I had the money to pay for an attorney to fight this - however with my OOP deductible of $1000 + 20%, it is taking everything to keep my medical bills paid. So, I fight this alone. I have been initially denied.. although I sent in a 1 year diet from 2001. I will have my psych eval on Tuesday. Once I get this, I plan on sending in an appeal with all of my medical records again, including documentation of where I was just diagnosed with obstructive sleep apnea and asthma. I don't know what to say in my letter since my appeal will be going to my employer. I do not want for this to affect my job. I have already sent them letters and they say that they stand behind BCBS's requirements. Some of you have been successful. Please share anything that you think would help in my appeal. Thanks! Beth M

There are sample appeal letters you can access by typing in "Appeal Letters" where it says search on the main page. Go to the WLS Library database. Why were you denied? What criteria does your plan state?

Scarlet, They denied stating that I did not have a 12 month supervised diet. But I did and it was included in the med records that I sent. I do not know if it was just not enough info for them or what the deal is. My next step is to appeal.

This is exactly what my plan is doing to me. After all the documentation they have over the past 5 years they still want me to do a Dr. supervised diet for 2 years. I havent been able to find a sample appeal letter to appeal this reason. Most appeal letters are only if you have been completely denied. I dont know about you but I cant wait 2 years. I am 27 and feel like I am ready to fall apart. Why cant they see what 1-2 years of our comorbidies can do to us? Do I need to suffer a heart attack before they will see? Sorry didnt mean to vent on your post. Let me know what you find out. PLEASE!! Good luck!

Hi I have BCBS of IL also. I'm jumping through their hoops as hard as I can. Your problem may be that your one year medically supervised diet has to have been within the last 24 months. Does your policy require that the one year include Nutritional Therapy (such as Optifast); Behavior Modification (what in blue blazes is that?); Supervised increase in activity: Pharmacologic Therapy; and Maintenance Support? I think they just want us to give up and go away! I intend to keep fighting. Everyone who qualifies for WLS knows that regular diets aren't going to achieve long lasting results. This is their way of keeping their money as we pay them their inflated premiums every pay period! Good luck.