Newbie here - BCBS of IL ?'s

Hello, I am new to the website.  Actually I've kinda lurked around for a few months but this is my first post.  I had my first appt with Dr. Hoeltgen July 3rd.  I am waiting for info from my insurance, BCBS to see if I qualify or not.  Can anyone tell me of their experience with BCBS?  I work for a hospital in the NW suburbs and my insurance card does not say "of IL".  The office manager of the surgeon tells me that more than likely I will need to do the 6 mos. of doctor supervised WL, a psych clearance and maybe something else.  Is there a place on this website to look up info about insurance and/or peoples experience with it?   I'd love to get any info. 
Thanks!

Hi, First of all, I would like to welcome you to the Illinois board. Please come and visit often. We have a daily roll call that almost everyone visits everyday, it also keeps us informed on what is happening in everyones world.

I have BCBS Anthem, out of Ohio, and what I did, before I even seen a dr was call them for their qualifications. This way I didn't waste my time or thiers. I had no problem getting approved and they they not need a 6 mt supervised diet.  So, my advice to you is start with your insurance company. They are the only ones that can help you at this point.

Again, welcome to the Illinois board, and we look forward to seeing more  of you.

Hi there and welcome to the Illinois board!

I also had my surgery with BCBS of IL, PPO.  As Carol and Lisa have said, the place to start is with your insurance company.  All policies are different, depending on what your employer has chosen to cover.

I had to have the 6 months doctor supervised weight loss attempt, been MO for at least 5 years, psych clearance, over 18, show willingness to comply with post-op nutrution and lifestyle changes, and surgeon acceptance.  Maybe a few other things as well, but this is what I remember (I do not have my papers here at the moment).  I did not have to have cardiology or pulmanology clearances, but I did not have co-morbidities in those areas.

Hope this helps.......

I have BCBS / Iowa, ppo and I had to have 6 mo supervised WL but, my ppc doc helped me with that with his letter stating I had tried actually for the last 10 yrs to only lose and gain weight. I had to get a phyc eval, and to get the BMI under 50 before final approval was granted.  I also checked with the insurance to see what was required before contacting my dr. WHich I will say most of the ppl who handle the insurance for this at the surgons office really know whats expected for most as far as insurance goes. So to clarify what the office manager told you call BCBS> You may also be able to get the info from BCBS web sight!

Karen

Hi,

I also have BCBS IL and basically the same experience as Dawn and Carol.  I was approved, but I decided not to wait and do the 6 month medically supervised diet because I was a relative "light weight" and was afraid that they would turn me down (I was told there is no guarantee they will approve it for real after the diet esp. if you lose a lot of weight) so I did self-pay.  However, BCBSIL did pay for whatever pre-surgery tests and labs that were required and not part of the self-pay.  I had a few co-morbidities so it was good to get thoroughly checked out.


Good Luck!! 

BCBS has loads of different divisions and all are a bit different.  Just cause you're in Illinois doesn't mean you have BCBS of Illinois.

Look ont he back of your card and call the customer service number.  Tell them to send you their requirments for getting approved for WLS.

Now hopefully you have already checked with your employer to make sure it's covered under their plan.  It's not the insurance company that woud exlude the surgery it's the plan the company has chosen to offer it's employees.

So hopefully your plan does comver WLS and you just need to find out what your BCBS requires to be done in order to submit for approval.  Your doctor's office should be able to get that for you if you run into a roadblock.

I first talked to the surgeons office manager as a starting point and she told me the same thing everyone here has been talking about - start with the insurance company.  So I did do that but they were not as specific as I thought they'd be. They did give me website to look at and it did talk about a 6 month doctor program, needing to be obese for 5 plus years, psych clearance...  I guess why I am confused is because I have talked to others with the same insurance and they said that even thought they were told they needed the 6 months, etc.. that they were approved without it - or that just fudged it a little and it didn't need to be a doctor supervised program. 

Thanks so much for all the replies!  I will check back often and am so glad to be a part of this group!  I need a good support group in this. 

Hi Carol,
can you tell me about your 6 month Supervised diet?  What all did you do, and your physician do?
Thanks!  Jeni

I did 1200 calories and logged in a book everything that I ate or drank that had calories. I turned that book into the surgeon's office after I completed my 6 month supervised diet. I also continued to log everything just in case. I did my 6 months thru the surgeons office not thru my pcp office. They logged my weight each month. Talked about what I was eating, what exercise I was getting done, how often. You cannot miss any monthly appointments or you have to start over. Always go on the same day of the month. If you start on the 5th, always go on the 5th or go a day early. The insurance did cover those monthly visits.
Good luck...any other questions you can pm me and I'll be happy to answer. 

Welcome to OH Illinois! I have BCBS IL and had to do 6 month supervised diet, psych visit, see a cardiologist and a pulmonologist.
When my surgeon sent in for preapproval I received a copy of the requirements in the mail. Each policy may be as different as the employer. You may need to call BCBS and ask them to mail you a list of requirements. Good luck on your journey!