Anyone Have Recent Experience With BC/BS of IL PPO

The dr will soon be submitting my paperwork for Lap Band surgery approval. What kind of read tape if any did you go thru? Anyone have any tips for me? Any info is greatly aprreciated. ~Nik

I also have BCBS IL PPO and I did the 6 month diet, did everything they told me to do...psyc eval and nutrition eval, letter on neccesity from pcp and so on and I was denied.  I don't want you to get discouraged, but BCBS I've heard tries to scare people away.  The reason they denied me was they said I did not have 5 years of MORBID obesity.  Also, I did not loose enough weight on the 6 month diet...which my plan do not say I have to lose a certain amount, they just say to be on a 6 month supervised diet.  Good luck and keep us posted to your porgress! Kim

Kim, remind me again how much weight you lost on the 6 mnth diet??  and also how many years of the morbid obesity were you missing? What is going on with your case?  are you still pursuing it?? 

Yep! Did you submit your 6 months sup diet and 5 yr history with iyour paperwork? Not to discourage you but I was denied for Lap Band with all documents submitted. My PCP and I re did my documentation and submitted for RNY and was approved with in about 3 days. They like to deny at first to discourage you but you have to be ready to go back at them. Good Luck

My 6 mo diet was with the paper work from weigh****chers and I had my ppc dr write a letter stating I had been trying to only regain after losing the weight, He stated that this had been going on for 10 plus yrs....I was approved on the first request....But I had to get the BMI down ubder 50.....This all started last Nov. Had my surgery in March 2007..... So my process went fast...I do have BC/BS of Iowa though....

Thank you all for your replies! I know better what to submit to the insurance co. I have the 5 years, and I think I have the six months..I'll have to check with my pcp when I see him later this week. I HATE feeling so anxious about this. ~Nik

I was denied on my first try because 'information was incomplete'.  Which was complete BS because when I spoke to a CSR at BCBS-IL they saw the pages in the system.  I requested a review and was approved without any additional paperwork.

Like others have said, they try to scare people off with a first denial....

Hi Nik! I have BCBS of IL PPO and it seems to be true that they deny the first request for various reasons. Just make sure that you submit proof of all of their requirements. You can get a list of the requirements at: http://www.bcbsil.com/member/obesity_management/om_medical_p olicy.htm Make sure that you can go right down this list and check them ALL off, and yes, they DO require that you have a five year history of morbid obesity to qualify for the surgery.  This would be proven by your yearly doctor's visits when they weigh you. You can also find information about Blue Cross's policy on Morbid obestity here: http://www.bcbsil.com/member/obesity_management/om_centers.h tm I had all requirements met upon first submission, except for the 6 month diet.  They are very strict about that, you must do it as THEY want it done, which was 6 monthly visits with weight.  The visits should be approximately 30 days apart and you must also discuss your eating and exercise with the doctor at each visit. Feel free to contact me if you have any other questions that I can help with.

I have BCBS of IL and I was denied. I had to hire a lawyer to file my appeal and it was finally approved.  I just had surgery on Dec. 10th.  They are bas$%^&'s.  They give you a hard time about everything.  Good Luck to you!

It's been almost a year for me and I'm still not approved.  Could you give me the name of that attorney maybe they can help me also. Thanks Kamillion