Do you think I'll Get approved - BCBS Illinois

Ok here's the deal - I gained 31 pounds during the 6 month nutrition visits. I have done everything else my insurance required. Do you think I will get denied. I am so scared. Here is what the official requirement says:


Documentation of active participation in a comprehensive, non-surgical program of weight reduction for at least six (6) months, occurring within the twenty-four (24) months prior to the proposed surgery. 


Doesn't Say anything about weight loss. So vague it scares me. I saw the doc for six months and "actively participated" so I am fine right ?

I just don't want to have to appeal If I get denied. Insurance scares me. Please pray I don't get denied. I guess worrying is not going to change anything, but I cant help but worry. I just want my stomach ripped out now. It is my worst enemy!

Everything is submitted. Now I wait. This SUCKS!!!!

Can you ask the surgeon's office to see if they have had situations like yours and what the outcome was?   They should be able to tell you if they have had the same thing happen to other patients with the same insurance.  Good luck

She just gave me kind of a generic answer like people get denied for different reasons. Grrrr. Oh well.

IMHO, you have a 50/50 chance depending on what your doctor/nutritionist put in their notes about what they think your chances of success are.

One school of thought says the purpose of this requirement is to show that you can commit to making the changes necessary in order to be successful at long term weight loss post-op.  If that's the case, gaining 31lbs doesn't look good.

On the other hand, BCBS could look at cases like yours as proof that traditional diet and exercise isn't effective, in which case they'd be willing to approve you in the hopes that surgery will triumph where other methods have failed.

I don't know of anyone that gained during that 6 month requirement (I lost 30lbs during mine), so I can't speak to having seen situations like this result in an approval, but maybe someone else can.

Good luck!

I have BCBS of IL also, they denied me a few times.  We just kept going bac****il they finally approved!  Just keep appealing...but if they do, make them state specifically what they want from you in writing, I feel like they jerked me around until I got angry and insisted on something in writing that was very very clear what they required. 

Good luck!

I have bcbs of IL. I never got a letter or had to wait the only thing they asked my physician is if I had tried to lose weight or even mentioned weight loss to my physician . I left the doctors office the coordinator who handles the claims called me that afternoon and said the surgeons office would be calling me to set up an appt and if I did not hear from them in a couple of weeks to give them a call. I can't understand why everyone has to go threw different hoops yes I had a very serious condition that required immediate weight loss but obese in itself can be and is serious. It just grieves me that some people who are so dedicated to changing have to go threw so much with the insurance company.

It does seem like not every case is treated the same, even within the same insurance plan. But, I had BCBSIL, and their policy at the time (January 2011) was that my documentation had to show FAILURE of a doctor-supervised three month diet. When I called to ask (called several times to make sure), they basically said that the documentation can show that I went up and down, but that ultimately, I failed.

Originally, I had lost about 13 pounds, but once I saw that wording, I stopped dieting (kept exercising) and promptly gained it back. I was approved right away. The only other suggestion I would give is that I found some resources online that I gave to my doctor to help her know what she needed to include in her notes. If you google "physician-supervised diet" you'll probably get some hits regarding documentation for WLS.

Good luck!

I have BCBSIL and was just denied on Friday.  I'm trying to get stuff together for an appeal.  I guess you'll just have to wait and see what happens.  But my fingers will be crossed for you.  I hope this appeal works for me too!  We deserve this!