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04-16-2007, 10:37 PM
| #1 (permalink) |
| Cub Reporter Join Date: Mar 2007 Location: IL
Posts: 68
Weight Statistics 03/03/2008 Surgery Date:
5' 3" Height: 276 lb Start Weight:
225 lb Current Weight:
140 lb Goal Weight:
51 lb Weight Loss:
85 lb Lb Left to Lose:
18.4782608696 % % Lost:
10/2009 Goal Date:
Body Mass Index 48.8858654573 BMI Start:
39.8526077098 BMI Current:
24.7971781305 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass |  BCBSIL PPO and the denial Well I finally got my first paper in the mail. It did not say denial but that they would look over the claim as soon as I have all the things they are asking for turned in. The things they need are, a letter of medical neccessity, medical history of morbid obiesity for 5 years, the BMI over 40, or less with comorbidities, and the medically supervised, diet/behavior modification/exercise for 6 months. Well the surgeons office has all my PCP charts from 2002-2007, they also type up the letter of medical neccessity, my BMI is over 40 and I have co-morbidities, and have been on the 6 month diet since April the 3rd. I know I have a ways to go on the diet, exercise part. I have done the pukmonologist, cardiologist, and psychologist already. So I guess now its down to finishing the 6 months up at the beginning of October and having them submit the papers. Hopefully I can get them to do it quickly so I can get approved (crossing fingers) without too much hassle. Then I can get it done before the end of the year. I knew it was going to be a no go from not having all of the papers in but it still left me feeling let down. I sure hope I don't have to fight with them later on. I have to call them and ask then is that a denial, or are they just waiting for the other paperwork. Well thats it for tonight, I am tired but I am not going to let them get me down. 
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04-17-2007, 01:23 AM
| #2 (permalink) |
| Super Moderator  | (((((HUGS))))))) At least, they haven't said an outright no. Keep on plugging, and trust that you will get it, never give up whatever they may say.
__________________ "In every job that must be done, there is an element of fun."   Just a li'l bit 'bout myself  |
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04-17-2007, 04:50 AM
| #3 (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)))))))) HOPE it all works out. I know more and more insurance companies are wanting the six month diet thing.... and i truely wonder, my surgeon submitted all my papers....but i wonder if his required pre op weight loss of 10 percent helps get around that being i didnt have to do that six months supervised diet thing. I have BSBC PPO and all i know is the surgeon handled the entire paperwork submittal and i didnt do a thing but go see all the doctors i needed for clearance! GOOD LUCK! and i hope its not a denial and its what your thinking just more paperwork needed to answer! thinking about you and will keep positive thoughts that this works out for you
__________________ LISA  http://w5.photobucket.com/widgets/dy...164/fr1endly2/ LAP RNY Gastric Bypass  |
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04-17-2007, 05:56 AM
| #4 (permalink) |
| Big Loser  Join Date: Dec 2006 Location: Northern NY
Posts: 118
Weight Statistics 5-23-06 Start Date:
9-13-06 Surgery Date:
5' 6" Height: 328 lb Start Weight:
192 lb Current Weight:
185 lb Goal Weight:
136 lb Weight Loss:
7 lb Lb Left to Lose:
41.4634146341 % % Lost:
yesterday ;-) Goal Date:
Body Mass Index 52.9348025712 BMI Start:
30.9862258953 BMI Current:
29.8565197429 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass | I also have BCBS PPO only I'm in NY. They did the same thing with me. They asked my surgeon's office for more documentation after I had done all my consults and testing. I think the final approval came in only 5 days before my surgery but they did approve it. Sending positive thoughts your way. Chrissy
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04-20-2007, 01:45 PM
| #5 (permalink) |
| WLS Master Guru  Join Date: Jan 2007 Location: Davenport, IA
Posts: 993
Weight Statistics 12/28/06 Start Date:
May 14, 2007 Surgery Date:
5' 5" Height: 253 lb Start Weight:
184 lb Current Weight:
150 lb Goal Weight:
69 lb Weight Loss:
34 lb Lb Left to Lose:
27.2727272727 % % Lost:
Body Mass Index 42.0968047337 BMI Start:
30.6158579882 BMI Current:
24.9585798817 BMI Goal:
| Blue Cross and Blue Shield of IL sucks! I had to send in paper after paper to get them to cover some of my CPAP machine. I don't know where you are in IL but I live in the Quad Cities in IA. I have Federal BCBS so they go through the state when your provider files. Luckily, my surgery center is in IA. No problem there. They even assigned me a case worker who said she will be getting back with me 3 weeks after my surgery and to call her if I have any questions at all. She is a former surgical nurse so she can help me if I need it. Of course I will go through my surgeons office, but it was nice to know. Hang in there they will eventually come around, but it is just a pain with all the paperwork back and forth.
__________________ Jeanne   |
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04-20-2007, 10:25 PM
| #6 (permalink) |
| Cub Reporter Join Date: Mar 2007 Location: IL
Posts: 68
Weight Statistics 03/03/2008 Surgery Date:
5' 3" Height: 276 lb Start Weight:
225 lb Current Weight:
140 lb Goal Weight:
51 lb Weight Loss:
85 lb Lb Left to Lose:
18.4782608696 % % Lost:
10/2009 Goal Date:
Body Mass Index 48.8858654573 BMI Start:
39.8526077098 BMI Current:
24.7971781305 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass | Cpap My insurance paid 90% on my sleep Dr. consulation, 90% on the sleep studies, I had 2 of them, and 90% of my Cpap machine with no problem. I always use PPO providers. I don't live in the City of Chicago, but in the southwest suberbs. It used to be farm country lol but now its nothing but subdivisions. Anyway I have never really had a problem with the insurance, but there is just so much to go through for the Gastric Bypass. I have my second weigh in on May 3rd and I am worried, my weight keeps going down some then up some. I don't even eat that much, as I have to eat 1200 calories or less, and I am on a gluten free diet on top of it. I don't know I was even sick one day and barely ate anything. Well, thats about it for me, I am just hoping at the end of the six months I get my approval. They have everything else they need at the surgeons office so they can send it in at the end of the 6 month diet. 
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04-21-2007, 12:38 AM
| #7 (permalink) |
| WLS Master Guru  Join Date: Apr 2007 Location: Near St. Louis, MO.
Posts: 947
Weight Statistics 04/17/2007 Start Date:
April 30, 2007 Surgery Date:
5' 5" Height: 296 lb Start Weight:
168 lb Current Weight:
150 lb Goal Weight:
128 lb Weight Loss:
18 lb Lb Left to Lose:
43.2432432432 % % Lost:
05/21/2008 Goal Date:
Body Mass Index 49.2515976331 BMI Start:
27.9536094675 BMI Current:
24.9585798817 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass | I have BCBS of CA. I went thru the Newstart program and they did everything. They told me all that I needed for my insurance co. Once I had everything turned in, I had an approval in about 8 days. My date is April 30th and I'm really nervous. Plus, I just came down with strep throat. I hope that doesn't postpone my surgery. But, bottom line, I want to be safe!!! I just feel kind of cheated, because I started my liquid diet today, and the past 2 days I've been so sick that I didn't even get to eat anything lol
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