Question:
Anyone had a denial overturned on appeal, BCBS of Illinois?

I was denied in 2007 because I didn't have a 6 month dr. supervised weight loss program. I saw my doctor everymonth from January to July. We resumbitted end of July and I received a denial August 8th, stating that BCBS was looking at the wrong policy and had not pulled my employers policy. I filed an appeal. Do you think it will be overturned???    — Suzanne R. (posted on August 20, 2008)

August 20, 2008
If your employeer's policy states no Baratric coverage, then little chance of coverage. Find out the wording they are dening coverage base on. Best of success to you.
   — William (Bill) wmil

August 20, 2008
Suzanne, Who knows what evil lurkes in the hearts of men and health insurance workers? I am not the Shadow, but I will say, even if it is not overturned, you MUST keep fighting. It is your life you are fighting for and you just cannot stop. Get your doctor to go to bat for you. Write letters like crazy, every day if necessary and call them 3 times a day. when all else fails, if it does, you'll have to find an insurance who will ok your surgery...it is just that important. Lyn
   — SkinnyLynni2B

August 20, 2008
That's their fault for giving you incorrect information. I have BCBS of TN. and at first they told me they would cover 100% if I qualified. After going thru all of the qualifications, I was informed that there had been a mistake and that they only covered 50%. I pitched a hissy fit! I knew the name of the person who had given me false info. to begin with so BCBS investigated and listened to the recorded call (all calls are recorded). Because of this proof they agreed to pay 100% due to their employees mistake. Never give up!!!!
   — AprilJM

August 20, 2008
I have BCBS of PA. I live in MI and I had to have 6 months of supervised weight loss with a nut/dietician and then only took less then 2 weeks to get Approved. I am so Thankful. 4 weeks out and 32 pounds lighter and happy as ever. Good Luck to you and I am sure God will guide that insurance co. to do the right thing.
   — [Deactivated Member]

August 20, 2008
I have bsbs insurance and was approved with no problems. They have different policy requirements for wls. Some of them require the 6 months diet plan and some do not. They do cover wls,so don't give up you should be approved.
   — Toby2

August 21, 2008
I have BCBS of NC and they too denied me the first go. I appealed with 3 letters of support from 3 different doctors, and typed a 5 page letter of how my life and my families lives had drastically changed with the weight and medical problems. I let my WL doctor file the appeal with all this information and in less than 2 weeks BCBS had approved the surgery. If they deny you again, ask your doctor about WL attorneys who help you appeal a 2nd time. FIGHT for your rights of good quality life.
   — bboykin

August 21, 2008
Ask your insurance company for the exclusions in your policy. I have BCBS of CA. They say that I am covered with a BMI of 40 or over and comorbidities. I have all that, so hopefully when my insurance is filed I will get the ok. Also, if it is meant for you to have this surgery then everything will fall into place. Keep fighting. I wish you well.
   — jenks621

August 26, 2008
I have BCBS of Michigan. I was turned down because of 6 month Dr. thing. Then if I saw my Dr. for 6 months they said I would be too old!!!! So I called my Dr. and they resubmitted it and somehow the BCBS OKed it the second time. I was delighted. Tell them to resubmit it. Then appeal it, if needed. Hope you get accepted.
   — GrammyAndy