BCBS IL HMO question about criteria

Hi.  My Husband's new insurance plan begins next month and we have had the Blue Cross PPO for the past couple years.  I have been recently trying to make sure all the PPO criteria are met so I can have surgery.  The problem is, next month he will be on the HMO plan for Blue Cross IL.  When I try to review the surgery criteria on their website, all it says is that the information is "it is not the same for patients on the HMO plan" and suggests that I coordinate my healthcare with my Primary Care Physician.  Does anyone out there know if they still look for the same criteria to be met, etc.  Is HMO easier to get approved than PPO?  Any info that anyone may have that might help would be greatly appreciated.  I have been unable to work for 3 1/2 years now due to major back surgeries, continuing problems and other conditions, and really need the surgery to help me begin to get back my life.  Thanks.

Hi Lyssa, I can't help you, since that is not my insurance, but just want to tell you good luck.The best place to start would be with your insurance company itself. Call and ask what the criteria is, and if they can or will send you the information. They should also give you a listing of which doctors are connnected to your new program.

From what I've seen it may be easier to get the surgery approved through the HMO.  The trick is to have a PCP who is supportive and then will help push the approval through their system. So, I would call the PCP first for an appointment and make sure that they are Pro WLS.  If not, time to change to another who is. Good luck!