Question:
Help with 12 month history from BC/BS of Ill

Can anyone tell me if they have BC/BS of Illinois and what they did for the documented 12 continuous months of compliance with medically supervised non-surgical methods of weight reduction? It says from an MD OR DO OR NURSE PRACTIONER. I am not exactly sure if I can write a letter or if it all has to come from a doctor? PLEASE HELP!!! I went down from needing 6 things on a list to just this one!!!! Or can you tell me exactly what you did to get approved from this insurance company?    — johnjo02 (posted on April 18, 2006)

April 18, 2006
Hey Johna I have the same insurance. I went through Barix Clinic and didn't have to do a thing. I went to the clinic and they handled everything with the insurance. It was great. Let me know if you want more info.
   — kristiegarcia

April 18, 2006
Hey girl, I have the same insurance and I used my Weight Watchers weigh in information. The person who handles the insurance at the doctors office said that it should work + you should have info in your medical records as well...any information on what you've done to lose weight "traditional" is what they're lookin for... and from what I hear they dont usually approve the 1st time but like Ive been told patience & persistance will usually pervail.
   — evelynvega

April 18, 2006
I now I just posted but just read the other comment about Batrix Clinic...they wouldnt even talk to me once they found out I had BCBS. I guess BCBS is difficult to deal with.
   — evelynvega

April 18, 2006
Evelyn read your comment, and I can't say that is true. I went in for my consultation and received my approval letter in 2 weeks. Surgery was just 4 weeks after consultation.
   — kristiegarcia

April 18, 2006
Hi I have BC?BS of Calif. and I had to do was provide them with all of the diets that I had done. I also was approved in 4 days.. I know it is ins. with a different state but I hope that gives some insight.. Good Luck.. :)
   — drunyan

April 18, 2006
I have the same insureance in New Jersey and they approved in 24 hours, really they was very easy for me. I will have the surgery on 4/25/06 and I quess is not difficut to deal with but you or your Dr. have to have the right paper work done. Good luck!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
   — janethjaquez

April 18, 2006
I also have BCBS of IL. I just received a denial after appealing for the first time. It seems that they did not even read the appeal. They are still saying that I don't have 12 continuous month of medically supervised weight management and I am going to ask my nurse practitioner to call them to ask EXACTLY what it is they need for approval. I am on my 5th month of monthly doctor's visits, but we provided all of the information from 15 years of "traditional" weight loss attempts and "failures", it's just that I did not go to the doctor once a month for the last 12 months. My last insurance did not have this requirement, so after 3 denials from them, I could not afford the time off of work and the expense of "weighing in" at the doctor's office. I was missing 6 months of seeing a doctor, so I had to start all over. I don't know if just going to the doctor and "weighing in" and talking about how diet is just not helping will do it or not. If you have been to the doctor once a month for the last 12 months, and did not miss any, submit your doctor's (or NP's) notes from each visit and please, let me know how it turns out.
   — berts4

April 19, 2006
Kristie.. I was merely stating what happened to me when I called the Batrix Clinic. I have absolutely no reason to lie about it, obviously we've all had different experiences with the same insurance company. Whenever I have needed help everyones experiences have always been helpful.
   — evelynvega

April 19, 2006
Johnna- Please don't read any of the responses from people with BC/BS from other states-they don't apply to your policy. I have Bc/BS IL PPO and let me tell you, there is absolutely no way around the 12 month requirement. When they say the 12 month requirement they mean: monthly visits with a nutrionist, and your PCP weighing in, discussing exactly what diet modifications you are making, tell them to be sure to write that in your notes. (i.e. patient is still following the low calorie diet, etc.). When meeting with the nutrionist, they want to see you making lifestyle "modifications" that would show a comittment to making them after surgery. In the beginning of the and the end of the 12 month program, meet with a psychologist to evaluate your mental health and if you can mentally meet the challenges of surgery. Every 3 MONTHS meet with a personal trainer, document your exercise plan with her/him and detail what activities you've done, etc. Make sure every thing has your weight on it, every visit, and if possible, your BMI. Take it from me- I am a pro. 3 year fight just ended and I won. Whoever said they have BC/BS and were approved without the 12 month requirement probably had HMO. HMO's have to approve if your medical group approves it. it's entirely different from a PPO. Read my profile for my details, as I outline specifically what I was told by BC/BS reps after being denied the first time, and second time, etc. I have a lot of valuable info in there for any one who needs it. ANd to whoever said (sorry I can't see the names of people replying) that they're in their 5th month and were denied, stop sending in for pre certification until you're done with your 12 months. BC/BS PPO does NOT qualify WW or Jenny CRaig or any of those places as a "MEDICALLY SUPERVISED WEIGHT LOSS ATTEMPT". they are not looking for that, they want to see you going to a doctor for weigh ins, check ups, progress reports, etc. EMail me with any questions.
   — Meghan R.

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