Question:
Can anyone help me with an appeal letter to BC/BS of Illinois, please?

I have been denied by BC/BS of Illinois, the reason for denial is as follows; There is no medical record documentation of medically supervised weight management including nutrition therapy, behavioral interventions, supervised increase in activity, food diary analysis and maintenance support. I don't understand what this all means and I sure don't understand how when I first talk to the reps at the ins. co. I was told as long as I met the criteria of being 100lbs. overweight, there should not be a problem getting approved. I have a bmi of 50.6, wgt. 323, hgt. 5'7. Co-morbidities include hypertension, gerd, diabetes, high triglycerides, and high cholesterol. My pcp sent in a letter telling them I had been on a diabetic diet plus exercise since 03-22-02. I think they're being very unfair. I started this process in June of this year, seems like they keep applying more rules to qualify every time I turn around, why don't the rules apply that were in effect when I applied? I see profiles of people with this same co. with less co-morbidities and lower bmi's getting approved. I just don't understand. Any help would be greatly appreciated. Thanks in advance. Kim    — Kim R. (posted on October 17, 2003)

October 17, 2003
Hi Kim, I'm just starting the process myself, but I wondered, do you have standard BC/BS or is it a PPO or Community Blue? Appearantly this can make a difference from what I'm finding out.
   — Jessica Wyatt Robinson

October 17, 2003
Hi Kim, My nightmare is that I'm going to be told just what you've been told. I was all excited when I read all the posts about my insurance company and how fast they approve things and then I just took the last information to my surgeon so that this can all be submitted and the insurance clerk did not make me feel good about my chances of being approved because I don't have any "PROOF" of Dr. supervised weight loss attempts, weekly weigh-ins, etc. in my near past... It's true, I haven't "dieted" much per se in the last few years because it has proven fruitless. I only end up heavier in the long run. One of the items I'm going to use in my appeal is some information I've found about the ill effects of yo-yo dieting and how bad it can be for your health. Why would they want me to do MORE HARM to my body. I just don't get it. The facts are there... we are over 100 lbs overweight w/ comorbidites. I'll keep you in my thoughts. Tamara
   — T C G.

October 17, 2003
I too was originally denied by BCBS IL and after battling them for 2 months I was finally approved. I wrote a letter that didn't help, sent in all my diet info and psych stuuf and actually printed out my member page from this site and faxed it to them. They are cracking down more and more every day, and from what I understand, in January of 04 will require 6 months documented diet AFTER you request the surgery. Honeslty, hounding them daily I believe did the trick for me...Just be blatant and ask the rep EXACTLY what they want, and then try to get it to them if you can. Don't give up! My surgery is in 5 days and I was where you were 1 month ago!
   — Amy E.