BCBS IL Changes in Obesity Surgery Policy

Hi everyone!  Brief intro:  I currently live in Chicago, I am 42, BMI of 42 too!  I'm going through the process of getting approved for weight loss surgery.  My insurance is BCBS IL PPO.  I wanted to put this out there for anyone interested:

As of July 1, BCBS IL has changed their requirements for qualifying for WLS.  They have changed their medically supervised diet requirement from 6 months to 3 months and they no longer require 5 years medically documented history of morbid obesity.  

I thought this might help someone who was in the same position as I was.  I don't go to doctors, and although I've been MO for my entire life, I had no medical documentation of it.

Here is the link:  
http://medicalpolicy.hcsc.net/medicalpolicy/home?corpEntCd=IL1&path=/templatedata/medpolicies/POLICY/data/SURGERY/SUR716.003_2009-07-01&ctype=POLICY&cat=Surgery#hlink

Hope everyone has a safe and fun 4th of July weekend! 

Thats nice to know. Hopefully thats a trend.

Thanks for the tip.  I downloaded the new criteria. Hoping anything BCBSIL changes - like this policy/criteria - immediately goes into effect for the company plan I have. I called BCBSIL service, and the person on the phone was not aware of the update.

Again ...... thanks for posting!!

Wow, at least you got someone on the phone!  I tried calling them too, and the recording said they were off for the holiday weekend.  

Why am I not surprised that the customer service person wasn't aware of the update?  Amazing.  Good luck to all!  I'm strapping myself in for a long fight with them, but for what I've paid monthly ($600) over the course of my life and have hardly used the coverage (save two uneventful pregnancies 20 years ago), I could have paid for this WLS a hundred times over.

Cheers!

Make sure to call the number on your card. Requirements can be different based on your employer. Just make sure to meet each requiremnet and document it well, you should be fine.

 

I'm hoping the confusion I had on the phone was only due to the policy change being so recent. I talked to my HR dept ............ if BCBSIL makes a change ............ it should always apply to me given our coverage.
I just sent a copy of the document, and the link, to their online question section. Hoping this will get me the 100% answer. 

Thank you for this post!  My Dr. is filing for my insurance and I have done 6 mos weight loss with the dr, and have everything else done, but I am afraid of being rejected for surgery.  This gives me hope that I will get approved.  The dr feels that it will be approved, but I have had doubts about it and now I feel hopeful.

I am starting my pre-op classes and have a tentative surgery date in August as long as the insurance approves. The six month wait was the worst. I'm ready!

Rose and Dr. Heydari know what needs to be in there.

I go this Tues. Add me as a friend and maybe I'll see you Monday night !