New HMO Illinois BCBS Rules Helping Anyone?

Well....I am still struglling with my insurance. I had to ACTUALLY have the referal coordinator from my PCP call my Group to inform THEM on the changes that BCIL implimented on 1-18-05! How can they not be informed?? Anyone...since this change has happened...Has this changed anyones luck w/getting approved for the surgery? Any type? Just curious...I am still waiting... Waiting some more...yep...still waiting... xoxoxojenn

It really depends on what policy you have and what your employers has signed up for. For instance, my employer has selected Blue Advantage as our coverage. My medical group is Dreyer, which is a FULL RISK medical group. Basically, what that means, if Dreyer approves the surgery, Blue Cross will cover it. They leave the decision up to my medical group. Perhaps full risk means that they will cover the cost if Blue Cross won't... I'm not sure. All I know is I keep calling Blue Cross to verify my surgery is covered and they keep telling me to not worry about it, if my PCP gives me a referral, it's covered. I haven't had any problems with Blue Cross. Good luck! Ed (your neighbor)

What exactly are the new rules? I'm trying to get approved with my current insurance before the end of Feb, because we change to BCBS of IL (PPO or HMO or Blue Edge, my choice) as of March 1st. I was going to select the HMO. Now I'm worried. I know the PPO makes you have the 1 yr supervised diet. Does the HMO do that now too?

Eek...What new rules? I am trying to get approved through my current insurance company, since my work changes insurance on March 1st to BCBS of IL (HMO, PPO, or BlueEdge, my choice). I was leaning towards the HMO, since I know that the PPO requires the 1 yr supervised diet. Now I'm a little worried???

If you go to www.bcbsil.com and hit the provider area at the top of the page, then go to the provider library. At the Library column Hit Medical Policies...I beleive, then it will take you to the info...hit 'i agree' and this brings you to the policy page! At the bottom left hand corner of the screen is the search area. Under the search area type in SUR716.003 and change it from Policy Title to Policy Number and hit search. This will bring up the policy BCBSIL HMO now has for Surgery for Morbid Obesity. It used to be 3yr supervised diet, now its down to 1 year which is much better! Hope this helps....good luck! xoxoxojenn