Question:
anyone w/BC/BS of illinois been denied for lack of 5 years of med supervised diet?

a prior auth request was sent to my insurance on June 30th. Insurance denied me on Sept 9th because they said they revised their guidelines on August 15th to include the patient has to have FIVE YEARS (can you believe it?) of a medically supervised diet. It is my understanding that Illinois state law provides that insurance companies are required to offer benefits for obesity-related problems. Does anyone know if this is true? So they aren't excluding it but they are making it impossible to access these benefits.    — Janice B. (posted on December 13, 2003)

December 12, 2003
JANICE I HAPPY THAT YOU ASK THIS QUESTION. I WAS ABOUT TO ASK THE SAME THING. I JUST SENT OFF MY INSURANCE PACKET AND I HAVE ONE SUPERVISE DIET FROM 2000 BUT I TRY TO COVER IT WITH MY DOCTOR WRITING A LETTER SAYING THAT ITS MED/NESS THAT I HAVE IT DONE.
   — MARLO M.

December 13, 2003
I have BC/BS of IL PPO I was denied because I didn't have documentation of at least 6-12 months of a doctor supervised diet. I appealed and they denied again. I am going to be sending in my second appeal soon. I have never heard of a 5 year diet requirement. Read my profile and email me I will be happy to let you know more. I thought this new Illinois law was for state employees but I am not sure.
   — Kara J.

December 13, 2003
Janice, please check the wording. Often there are two separate requirements: 1. that you have a 12 or 26 week (the time varies by insurance company) supervised diet, and 2. that you have been morbidly obese for at least the past five years. It sounds like these two requirements have gotten mixed up.
   — Vespa R.

December 13, 2003
I had open RNY August 25. I saw my doctor last week & he told me I was lucky to have the surgery when I did because now BCBS-HMOI requires a 5 year supervised doctor's diet. I count my blessings. Good Luck
   — Vicki V.

December 13, 2003
I was just approved by BCBS of illinois. I had a two year medically supervised diet and I also had all my medical records for the past 5 years that showed my weight and that the doctors said my problems were all related to my being morbidly obese. BCBS of Illinois sends all requests to a review board. I was approved in 5 days. When I originally called BCBS, they said that the requirements for our group insurance was that it had to be a medical necesity, and be a least 100 pounds overweight. I have a PPO plan. My co morbidities were arthritis in my knees, back pain and swelling in my ankles and legs and bouts with heartburn. I had my gallbladder out 5 years ago. There is also a history of hypertension and diabetes in my family history. I wish you luck.
   — 1happylady

December 13, 2003
Blue Cross Blue Shield of Illinois sent me this information not long ago. I have been on a diet under my PCP since October. I'm going through all the stages to get this surgery. MD evaluation with Patients presenting complaint. Hight/weight. BMI, list of diet history and exercise programs with results of 6 months medically supervised weight loss notes.
   — CuteDonna

December 14, 2003
I'm with one of the other posters. I would bet it's a 5-year history of being morbidly obese. I have heard that BCBS of anywhere is putting a the 6 or 12 month supervised diet piece in place also, which would make more sense than 5 yrs. So glad I got my surgery when I did, although I could have complied with the requirements if they are as I stated. I hope you can figure something out! Ask to present your case personally to the appeal board. Can't hurt!!
   — zoedogcbr

December 14, 2003
I would fight it based on the date they received the informaiton. They changed the guidelines midway through the review, but they have to review the authorization receved before that date under the old guidelines. I have worked in insurance for over 10 years and we always had to go by received date, not the date they finally got around to reviewing. Fight it, file and appeal and if you have to, file a complaint with the Insurance Commissioner.
   — Cheryl H.

December 15, 2003
thanks to all who replied. I have hired Walter Lindstom and am getting anxious to see what if anything he can do for me. Thanks again
   — Janice B.

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