Question:
Has anyone been recently denied by BCBS of IL PPO?

I was just denied by BCBS of IL PPO. Weight for Life (the group who does the insurance verification for Alexian Brothers Hospital) says that it's very odd that I was denied. The reason BCBS gave was that "patient has failed to demonstrate proof that she can conform to a healthy lifestyle." This is unbelievable to me as I have an *extensive* diet history including several diet drugs. Also, my PCP has written a letter stating RNY is medically necessary and has listed my co-morbids. So, now I'm starting my appeal letter and need any helpful hints anyone can offer. Thanks in advance, Jeannie    — girlstar (posted on July 9, 2003)

July 9, 2003
I suggest that you ask that your request be reviewed again and then go to the appeal as a last resort. BCBS PPOs are wonderful, but are sometimes tailored to specific needs of the provider. I would think that "failing to conform to a healthy lifestyles" would be justification for surgery, not denial. If I had conformed to a healthy lifestyle, I wouldn't have had WLS in the first place! I have BCBS PPO of MA and had no issues with approval. I hope that things go smoothly for you in the future!!!Best regards, Barbara 312/207/190
   — Barbara M.

July 9, 2003
Hi Jeannie, I have the same Ins. that you do and I got approved first time. You might check to see the letter that the doctor sent to the insurance and make sure he has written down EVERYTHING. I never looked at what my doctor wrote but I remember the insurance co. wanted the past 5 years of trying diets. Good luck to you, keep the faith.
   — Kim J.

July 10, 2003
Your individual policy thru your employer may be different than mine, mine was approved almost instantaeously.
   — **willow**

August 16, 2003
hey gal i was also denied for the same reason i am currently in the apeal process of this journey and i have also contacted a lawyer please if you can help let me know samantha p.s i will also keep you up to date on mine as well
   — samantha C.