Better for Banding Approval...BCBS of IL HMO or PPO?

We're changing insurance companies March 1, 2005. I am in the process of trying to get approval through my current insurance company and get surgery done before then. (Everything has been submitted, just waiting now.) However, in the more likely event that I must wait, I wanted to see which has a better chance of approval. From my research online, I have deduced that BCBS of IL PPO requires 1 yr. medically supervised diet. Is this the case, or do I have it backwards, and the HMO requires it? I know it depends on the IPA, etc, but I do know for sure that our new plan will not have exclusions for the surgery from my company. (HR says there are no exclusions like that to our insurance..does this sound normal?) I am not 100% on exactly what the details of the new plan will be. Thanks to anyone who can offer any personal experience!

I by NO means am a BCBS expert - I just wanted to tell you the little bit of what I know. There are several woman in our clinic that have BCBS - some are PPO and some are HMO, and from what they've told me, the requirements for both are almost identical. Does that help?

Let me just say, do not waste your time or money switching to BC PPO. I have done everything they ask and still DENIED yesterday! I know of three people that were denied this week ppo. they are doing everything they can to deny people! We all got the same excuse, "lack of documentation of a supervised diet". Then, we all got told different stories on what we needed to get, plus they won't tell you if you will for sure be approved if you get what they ask! It's a joke! Take my advise, don't waste you time! Sorry to be the bearer of bad news, but I had to find out the hard way!! Michelle

Hi I have BCBS of Mn ppo, I just listed every diet I had been on in the last 10 years. I was approved with in 10 days.. My surgeon's office took care of everything.I hope this helps. Tina

Thanks for all your replies. I am in the process of getting approved from my current insurance company, TRYING to get it done before the end of Feb. I am just not letting myself get my hopes up, even though the precert people at the insurance company were positive. The girl I've been talking to went out of her way to get my faxed paperwork and start my case for me, and she said to call back on Tuesday to see what the status is. Any how, I'll do some more research on the PPO vs HMO, since I have to chose one. I'm personally not a huge fan of having to get referrals for specialists, but if I cannot get approved through my current company, I may have to go the HMO route to get the surgery approved. Either that, or I'll end up on the 1 year diet and trying again in the future. Thanks again for your posts.

Amy, You might want to ask you PCP about chances of approval under an HMO. The medical group is the decision maker when you have an HMO and if he/she can't or won't approve you will be stuck there for a year or forced to keep hunting a medical group that will approve. That being said, while you're there you can start the process of monthly weigh ins etc. The last criteria my doctor gave me before I switched included supervised diet / excercise and required a 10% weight loss. Guess what I'm saying is make sure of the HMO requirements and your doctor's support either way and remember that you can work on the PPO requirements while you're still on the HMO (that's what I ended up doing) so you don't lose a year of the process. Illini