Just Starting...HMO Illinois ?

Hello everyone! I am just starting my journey to get the insurance to cover this surgery! I was wondering if anyone out there who has HMO Illinois (BCBS) has gotten by without getting all the requirements to qualify to get the surgery. I did WW for 2 yrs and went up and down weight wise...and now that won't count for my doc supervised diet. My PCP is the one who told me to try WW first. I am a bit frustrated about this! I need some guidance thru this insurance woes I am so to be had (so I hear)....HELP!!!! Thanks for listening and sharing! xoxoxjenn

Jennifer, I just switched from the BCBS HMO to the PPO. With the HMO, the medical group your doctor is a part of controls whether or not you get the surgery. So having a supportive PCP is really important. BCBS provides guidelines. The last guidelines my PCP shared with me for HMO Illinois required a 10% weight loss on top of everything else. If your PCP is supportive of WLS, work with him/her. But be ready to do your own research as well. For the most part it seemed that I knew more about the insurance requirements than my PCP. She's been very supportive of my efforts (other patients of her's have had WLS and good success) and I'm working with her to meet the PPO's requirements (1 year doctor supervised weight loss effort). The minute I thought I wanted the surgery I started efforts to comply with the insurance requirements and my PCP has been working with me. I'm now more than half way there and have scheduled a consultation with a surgeon in March. I should be able to get surgery sometime after June 1 (one year after I started the physician supervised diet). It has gone by faster than I thought it would. I recommend that you find out the requirements for WLS and start working them, rather than putting all your efforts to trying to get around them. That way, if you don't manage to work around them you'll be that much closer to getting the surgery. Also, there are a lot of folks on this board battling BCBS. I'm sure you'll hear from them as well. I wish you the best of luck! Illini