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10-26-2007, 09:34 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 |  Denied by BCBSIL Hello, just thought I would let you all know it took them 3 days to give me my denial. They said because 1200 calories is not considered a very low calorie diet. They told me it has to be between 800-1000 calories. Funny the requirements don't state it anywhere. I was on a Dr supervised diet, through a dietician who is affiliated with the surgeons office. I know they would know what the ins. co. would want. I am so down in the dumps over this. Of course I blew my top lol and told them once I got the denial letter I would get whoever involved that I needed to. Boy did that make the girl quiet, she was pretty condiscending when she was telling me the reason for denial. Now I am stressing about what to do next. I am certainly not doing the 6 month diet all over again. Yet if that is their reason for denial, that means if they get other info or whatever about the diet, and that is approved by them then I will be approved right? Thanks for listening to my rant. Cherri
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10-26-2007, 09:49 PM
| #2 (permalink) |
| WLS Guru Join Date: Jun 2007 Location: Arizona in the winter - Colorado in the summer
Posts: 395
Weight Statistics about age 12 the first time Start Date:
8/29/2007 Surgery Date:
5' 4" Height: 268 lb Start Weight:
147 lb Current Weight:
140 lb Goal Weight:
121 lb Weight Loss:
7 lb Lb Left to Lose:
45.1492537313 % % Lost:
a year from Christmas Goal Date:
Body Mass Index 45.9970703125 BMI Start:
25.2297363281 BMI Current:
24.0283203125 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass   |  Cherri I am sorry that this happened - it would have been nice if they had specified the type of diet they expected you to be on up front. My husband did WW which is over 1200 and was approved. I don't remember being asked how many calories I had each day before mine was approved. sure hope they change their minds on this Judy
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10-26-2007, 09:56 PM
| #3 (permalink) |
| Seasoned Veteran  Join Date: Apr 2007 Location: Mount Vernon, NY
Posts: 7,369
Weight Statistics 4/1/07 Start Date:
4/19/07 Surgery Date:
5' 9" Height: 258 lb Start Weight:
151 lb Current Weight:
165 lb Goal Weight:
107 lb Weight Loss:
-14 lb Lb Left to Lose:
41.4728682171 % % Lost:
04/19/2008 Goal Date:
Body Mass Index 38.0957781979 BMI Start:
22.2963663096 BMI Current:
24.36357908 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass   | WOW. i cant believe that. im sorry that you are having such a difficult time. is there a supervisor or manager or someone you can speak to??
__________________ Anything worth having is worth working for Kenya R.  Lap RNY 4/19/07     |
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10-26-2007, 10:07 PM
| #4 (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 | Thanks Judy and Kenyar Thanks, it is always nice to know I have support here. I did ask for a supervisor and was told that was the reason for the denial. I just don't see how they can say that when its not in their requirements. If I had more money I would hire a lawyer just on the principal of the whole thing.
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10-26-2007, 10:56 PM
| #5 (permalink) |
| Seasoned Veteran  Join Date: Aug 2006 Location: WADING RIVER (Long Island), NY
Posts: 4,860
Weight Statistics 7/16/07 Start Date:
7/16/07 Surgery Date:
4' 11" Height: 230 lb Start Weight:
139 lb Current Weight:
115 lb Goal Weight:
91 lb Weight Loss:
24 lb Lb Left to Lose:
39.5652173913 % % Lost:
12/31/08 Goal Date:
Body Mass Index 46.4492961793 BMI Start:
28.0715311692 BMI Current:
23.2246480896 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass | Wow Im So Sorrry You Going Thru This Hun. Ive Never Heard Of Such Crap. Why Dont They State This In Their Requirements. What Bs!!!! Again Im So Sorry
__________________ 3/2008 PREG. START WT 144LBS. GOAL WILL HAVE TO WAIT TILL AFTER BABY  230 lbs 7/2007 & 142 lbs 4/2008     |
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10-27-2007, 02:57 AM
| #6 (permalink) |
| Seasoned Veteran  Join Date: Jun 2007 Location: Jacksonville, Florida
Posts: 4,004
Weight Statistics July 21, 2007 Start Date:
August 6, 2007 Surgery Date:
5' 2" Height: 287 lb Start Weight:
169 lb Current Weight:
140 lb Goal Weight:
118 lb Weight Loss:
29 lb Lb Left to Lose:
41.1149825784 % % Lost:
January 1, 2009 Goal Date:
Body Mass Index 52.4872528616 BMI Start:
30.9071279917 BMI Current:
25.6035379813 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass | APPEAL!!!!! I would get all of my paper work started on the Appeal process. How can they say that 1200 is not appropriate when everything is based on a 2000 calorie diet? No, something does not sound right at all! Right now is the best time to get your appeals into BCBS, they are having so many problems right now that they are getting the Appeals in and processed quickly. Please dont stop here and get upset, that Appeal process is there for a reason. Let me tell you this...there are some instances where certain claims are REQUIRED to go to a medical consultant for review, but sometimes they never quite make it there and the examiner denies it and gets it out the door. In the appeal process, it will go to someone with more knowledge than what an examiner has. I am so sorry that you are going through this. I wish you luck! |
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10-27-2007, 09:06 AM
| #7 (permalink) |
| Seasoned Veteran  Join Date: Jun 2007 Location: North Texas
Posts: 3,260
Blog Entries: 1 Weight Statistics I've lost/gained my whole life!!! Start Date:
Aug 1, 2007 Surgery Date:
5' 8" Height: 280 lb Start Weight:
148 lb Current Weight:
150 lb Goal Weight:
132 lb Weight Loss:
-2 lb Lb Left to Lose:
47.1428571429 % % Lost:
Summer 2008 Goal Date:
Body Mass Index 42.5692041522 BMI Start:
22.5008650519 BMI Current:
22.8049307958 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass | don't let up and stay on them until they cave!!! Definitely go up the ladder until you get someone who will listen (I like to send certified letters too....return receipt to prove they got it with a CC: to my attorney)!!! |
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10-27-2007, 09:52 AM
| #8 (permalink) |
| Seasoned Veteran  Join Date: Mar 2007 Location: Floyd County Virginia
Posts: 3,591
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 | I would appeal the decision. The calorie thing just dont sound right to me. Your Drs office is the one who will have to file the appeal based on the records you have give them. |
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10-27-2007, 01:23 PM
| #9 (permalink) |
| Seasoned Veteran Join Date: Apr 2007 Location: Mount Vernon, NY
Posts: 7,369
Weight Statistics 4/1/07 Start Date:
4/19/07 Surgery Date:
5' 9" Height: 258 lb Start Weight:
151 lb Current Weight:
165 lb Goal Weight:
107 lb Weight Loss:
-14 lb Lb Left to Lose:
41.4728682171 % % Lost:
04/19/2008 Goal Date:
Body Mass Index 38.0957781979 BMI Start:
22.2963663096 BMI Current:
24.36357908 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass | i've been thinking about this all night. it actually bothered me while i was sleeping LOL! i just wanted to say, and i might be wrong, but HOW could you go on an 800 calorie diet? thats just about what we are eating post op...somethings fishy. appeal!
__________________ Anything worth having is worth working for Kenya R. Lap RNY 4/19/07 Last edited by Kenyar : 10-28-2007 at 05:42 AM. Reason: typos...as usual LOL! |
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10-27-2007, 09:18 PM
| #10 (permalink) |
| Seasoned Veteran  Join Date: Mar 2007 Location: Texas
Posts: 1,558
Weight Statistics 3-16-2007 Start Date:
July 23, 2007 Surgery Date:
5' 7" Height: 284 lb Start Weight:
178 lb Current Weight:
160 lb Goal Weight:
106 lb Weight Loss:
18 lb Lb Left to Lose:
37.323943662 % % Lost:
7-23-08 Goal Date:
Body Mass Index 44.4758298062 BMI Start:
27.8756961461 BMI Current:
25.0568055246 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass | Definetly you need to appeal. that just doesn't make sense. Sometimes I think they like to test us to see if we will take the no and stop. Appeal!!!
__________________  I am only as strong as the caffine I drink, the hairspray I use, and the girl friends I have.  |
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