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  679 People Lost in total 60538 lbs = 29.53 % Give us permission to add your before & after Weight Loss Photos |   |
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02-23-2007, 06:56 AM
| #1 (permalink) |
| Newbie |  BCBS IL 6month diet help Hi. I am new to this site and have been trying since April 06 to get approved. The only thing my ins co is hung up on at this point is my 6 month diet, which is in its 10th month. They say they want MORE DETAILS from my doctor. I have sent in my office visit notes....explaining that I am under his care and continue to be I am exercising etc. But they say they want more detail, but that is all the details they will give me. Anyone else have this problem? Any ideas or suggestions???? My carrier has quit covering this surgery as of 1-07...HOWEVER since I was in the process prior to this date, IF I can get approved, they will cover it. This is my last chance. ANy help or suggestions are welcome and appreciated. Vickie |
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Yes, you can often get insurance cover for your Weight Loss Surgery. Our own Craig "Big-T" Thompson has been there and done that, and he's written an e-book about it.  |
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02-23-2007, 07:23 AM
| #2 (permalink) |
| Seasoned Veteran  Join Date: Jan 2006 Location: SOMEPLACE LONG ISLAND, NY
Posts: 6,756
Weight Statistics June 1, 2005 Start Date:
Height: 310 lb Start Weight:
167 lb Current Weight:
159 lb Goal Weight:
143 lb Weight Loss:
8 lb Lb Left to Lose:
46.1290322581 % % Lost:
Body Mass Index 51 BMI Start:
27 BMI Current:
Weight Loss Method Roux en Y Gastric Bypass     | ((((HUG))))) i didnt have problems with my EMPIRE blue shield blue cross PPO.. but i also had the surgery in 2005. FIGHT THEM! WORK it and try to get all the help you can from your doctor to resolve this. BEING your case opened before they changed the guidelines you dont want to loose that. ((HUG))) i can only imagine the heart ached and stress this is causeing you!!!!! Im sure others will advise you from there situaitons as well.I also thought maybe this book can help you: The Weight Loss Surgery Insurance eBook! I really hate you to loose this battle!!! GOOD LUCK
__________________ LISA  http://w5.photobucket.com/widgets/dy...164/fr1endly2/ LAP RNY Gastric Bypass  |
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02-23-2007, 08:22 AM
| #3 (permalink) |
| Cub Reporter  Join Date: Jan 2007 Location: Houston, Texas
Posts: 82
Weight Statistics 1-27-08 Start Date:
2-22-08 Surgery Date:
Height: 283 lb Start Weight:
270 lb Current Weight:
150 lb Goal Weight:
13 lb Weight Loss:
120 lb Lb Left to Lose:
4.59363957597 % % Lost:
2-14-09 Goal Date:
Body Mass Index 47 BMI Start:
27 BMI Goal:
Weight Loss Method Sleeve Gastrectomy | My suggestion would be, have your doctor refer you to a Dietician and the Dietician should be able to help you. Mine has. My insurance required a 3 month doctor supervised diet, so my PCP referred me to a Dietician and she is requiring that I keep a daily food journal and where a pedometer. I must also record daily steps and exercise. I have heard that is you are a member of a health club, they could possibly print out when you come in and out. I have to check in with the Dietician on a monthly basis and then I check in with my PCP. Double the coverage and there is a small cost envolved, but not as much as if you have to pay cash for your surgery. Good Luck and try the book Fr1endly2 suggested.
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02-23-2007, 08:24 AM
| #4 (permalink) |
| Super Moderator  | Has your dr given details like 1) How many calories has he/she instructed you to take, what type of diet, regular balance (as recommended by FDA), high protein, low fat, low cal diet and such. 2) Your month to month weight, how much have you lost, or have you gained any back. 3) What kind of exercise and how much. You probably need to be detailed and precise about what you have done, a point on point account of what is said and done with each dr's visit. In other words, I think they want to know you are making a serious effort and gearing yourself to the life style change you need to make post op. Insurance cos want the info in their language, not yours. Also, there are certain wordings and context you have to style your info in, even if what you are actually saying is the same. The book link fr1endly2 has given you should help you in this respect. ((((((((HUGS))))))) May your journey go well.
__________________ "In every job that must be done, there is an element of fun."   Just a li'l bit 'bout myself  |
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03-27-2007, 06:38 PM
| #5 (permalink) |
| Whipper Snapper Join Date: Mar 2007 Location: Flagstaff
Posts: 14
Weight Statistics which time Start Date:
5/4/2007 Surgery Date:
Height: 284 lb Start Weight:
247 lb Current Weight:
140 lb Goal Weight:
37 lb Weight Loss:
107 lb Lb Left to Lose:
13.0281690141 % % Lost:
4/11/2008 Goal Date:
Body Mass Index 50 BMI Start:
42 BMI Current:
24 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass | Vicki, send in food Journals, exercise journals. they are telling me that my doctor has to comment on what I am doing. make sure your doctor just dictates endlessly about what you are doing. Remember Ins. doesn't make money by paying claim. They deny, deny, deny. that is what they do. Call the insurance commission. if it is a self funded plan call the department of labor. file complaints. call your company. they don't want to pay for it. get busy I am still fighting. I told them I wasn't giving up.
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03-30-2007, 10:15 PM
| #6 (permalink) |
| Seasoned Veteran  Join Date: Mar 2007 Location: Floyd County Virginia
Posts: 3,608
Blog Entries: 1 Weight Statistics September 19th 2007 Start Date:
September 19th 2007 Surgery Date:
5' 10" Height: 363 lb Start Weight:
211 lb Current Weight:
165 lb Goal Weight:
152 lb Weight Loss:
46 lb Lb Left to Lose:
41.8732782369 % % Lost:
12/31/09 Goal Date:
Body Mass Index 52.0793877551 BMI Start:
30.2720408163 BMI Current:
23.6724489796 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass | Personally I would call them directly and ask them what the hang up is. Let them know you have followed all the directions you were given. And how long its been. Then tell them if they cant reach a definate decision within a reasonable time you will report them to the insurance commisner. They will start moving faster. Trust me. |
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03-31-2007, 09:19 AM
| #7 (permalink) |
| Whipper Snapper Join Date: Mar 2007 Location: Flagstaff
Posts: 14
Weight Statistics which time Start Date:
5/4/2007 Surgery Date:
Height: 284 lb Start Weight:
247 lb Current Weight:
140 lb Goal Weight:
37 lb Weight Loss:
107 lb Lb Left to Lose:
13.0281690141 % % Lost:
4/11/2008 Goal Date:
Body Mass Index 50 BMI Start:
42 BMI Current:
24 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass | Ms Vickie, I have called the Insurance commission, the Dept. of Labor and the company. they are in violation of a federal regulation regarding the time they have to respond to my appeal. No on seems to care and the company won't return my phone calls. last time I talked to them they said they were in agreement with BCBS even though they haven't seen my records or even looked into my case. They based their decision on the standard lies and delay, deny, deceit tactics of the insurance company.
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