blue cross blue shield of illinois (PPO)

Hi I have bcbs of Illinois, my husband is a member of Teamsters Local 710. I want to have this surgery! Does a PPO which this is, (require) a 12-18 month supervised diet plan on a monthly basis, or is it the doctor? I am going Thursday to my first visit with my doctor. Any suggestions about any of this stuff would be greatly appreciated. thank you .

From what I understand, it's BCBS that requires it. If you really want to do this, I recommend starting NOW. Time will fly and everything will be taken care of.

Actually, it goes according to your insurance plan. You don't have to wait for someone to tell you this stuff, you can ask your insurance company. They won't fault you and it won't count against you for asking. Plus it'll give you peace of mind to know and understand clearly what hoops they expect you to jump through. I have BCBS but it's through an out of state provider. All I had to do was have a psychological evaluation and letter from the psychologist saying I'm fit to have the surgery. So it depends on your insurance plan. CALL THEM RIGHT NOW! If you talk to them ahead of time and find out what pre-requisites you need, you can be prepared for what the doctor requires and you're already a step ahead of the game! Good luck!! Stef

I ditto what Stephanie says!

thank you everyone for your help I greatly appreciate it. I have a bmi of 35 almost, well I am 5 " 5" AND 211. I have urine incontinence, I have severe lower back and left hip pain, I had gestational diabetes years ago, but I have legs spasms at nite, and feet are very cold and numb, I need to wear socks most of the time, mainly to bed maybe two pair. I have gastoesphageal reflux, I vomit in my mouth, YUK! most of the time. I have depression from the weight, and the medication made me gain more weight. Anyways, I called the insurance co, they have a reference number and a caseworker for me. The woman said I need to write a 18 month history on my attempts to lose weight, and how it failed. And I need my family doctor to write letter supporting the surgery for me, and why he feels I should have it , co morbidities, so on. I hope he does this? If he doesn't can I find another doctor to write it? I don't know why he wouldn;t I have two years worth of notes from his office on my weight loss attempt. I will know tomorrow if he will write it. And the insurance company said it takes a couple of days after all the info. is submitted, I asked her if I would be on my way to skinny in a couple of weeks and she said probably so!!! I won't get my hopes up though, well kinda. My daughter is getting married in March, she wants me to walk her down the aisle, since her dad died. I feel ashamed, saying I am too fat. I have an appt with dr. julius rivera on thursday. Gosh, I hope this works, thanks!!! Do you guys think my weight and bmi are too low for this surgery? The insurance co said they consider it still, even so, they look at the urince inconsistence, joint pain also, and base it more on this than the other. thanks

My surgeon's office wrote my letters to insurance.. including the medical necessity letter (the one you're trying to get from your PCP). If your doctor thinks you shouldn't have it, even after repeated and failed attempts, I would want to have a clear explanation as to why. Keep a log of the things you're doing now so that when you go to the surgeon, you can discuss what you've learned so far with him. You'll be fine, Elizabeth! Stef

thanks to you guys

Just make sure you get names and phone numbers at BCBS because the will tell you one thing and do another. Keep good records of what they want Good Luck Jeff

Hey!! Temporary Hijack..... Jeff!!! Long time no see!!! How are you guys doin??!!

We are good just real busy getting Gina's company open. Other than that just loosing away last week was 3 months and I am down 88-90 pounds it jumps up an down. Also we started working out this week so I am real sore all over. Hope things are good with you Jeff