New BCBS IL Policy on Surgery

Yes, I cought the change in the Psych eval. I wonder if they will make me do another one? I had one by a psych in the Dr. office. To be honest, if you are going to a require a psych eval, it does make sense to have it be independent. I saw a psychologist through the surgeon's office. I am sure he won't get much future business if he says people are not a sutiable candidate.

I thought the difference was you must have two or more of the items they had listed (pre Jan. 18), now it says you must have the ALL??? My info is in "medical review" right now with them. It has been since 1-13-05, so do you all think the new policy would apply to the ones submited before 1-18?? They will probably just try to find some other excuse to deny!!! I am ready to just self pay... I am too impatient to jump thru their hoops! Michelle

I'm not sure - the text still reads the same as it did before it just looks like the bullet points got moved out. The way it read before you had to have at least 2 co-morbs if your bmi was less than 40. Do they require at least 2 co-morbs for 40+ bmi as well as 35? Not sure. Also, they have RNY of 125 listed as investigational or experimental (and not covered) in one place. And, it looks like there were formatting issues down by the pysch coverage. Think they didn't proof read this draft very well. Does just moving the bullet points out mean that you have to have all co-morbs listed? Or is it a formating mistake? Illini

Meant to say that they have RNY 125 listed as investigational or experimental in one place. Sorry - think I undid more than I thought I was undoing! (Speaking of proof reading errors!) Illini

Okay one more time with words, not symbols!! They have RNY of less than 150 cm listed as a covered procedure in 2 places in the policy and RNY of greater than 125 cm listed as investigational or experimental (and not covered) listed in one place. Less than 125 used to be the limit for a covered procedure and I think they just missed the other reference. Illini