BCBS OF IL -PPO HELP!!!

I have been denied a bunch of times already. Anyone out there recently have surgery( last 6 months or so) Looking maybe for qualified legal help in the Chicago/Dupage area. Think it could be my company. At wits end. Thanx Chuck

Chuck, There was just a post yesterday afternoon on this very topic - on the main boards. You may want to read it for some contacts. Also, one of the posters mentions that Walt Lindstrom (obesitylaw.com) is putting together a case against BC/BS IL. Walt is a California attorney who has apparently had some success with challenging insurance companies. He works out of and is licensed to practice in California, but is able to provide some assistance outside of California as well. I've been to the website and found it helpful for links and such. That being said, I don't have any direct personal information about Walt. I imagine that you'll hear from a lot of folks on this board pretty quickly as this (BC/BS IL PPO) has been a pretty hot topic off and on. Jeff Flancbaum who's on this board fought BC/BS but in the end gave up and got other insurance which paid for his surgery. And there are others out there with a story to tell. As I understand it there are 2 things that you need to look at in dealing with the insurance company. 1) your company's policy and whether or not it contains an exclusion for WLS. You should get a copy of the policy from your HR department if you haven't already. Exclusions can sometime be successfully fought if they are poorly worded, but a lot of that bad wording has been cleaned up. 2) If WLS is covered under your plan, you also need to see the criteria for coverage. That is posted on the BC/BS PPO IL site - if you go through the providers section, you can find it. There it lists BC/BS's internal criteria for coverage determinations. If you can't find it email me and I'll send it privately or maybe someone *****ads this will post directions (that's how I found it afterall). Am also hearing that if you get the approvals, you might have to fight anyway to actually get them to pay for the surgery. Have heard several stories about people who get approved to have the surgery and then have to battle to get BC/BS to actually make them pay the bills. I'm starting to get nervous as my insurance submissions are trickling in and will be done this month and my surgery is scheduled for the end of July. Not looking forward to a big fight, but getting ready for one just in case. Wish you the best of luck, San

Chuck, Almost a year ago I submitted my paperwork for surgery to BCBS of Illinois (PPS plan). They told me they would not approve my surgery until I had a year-long doctor supervised weight loss program. I decided I wouldn't fight it since I probably would lose, besides in my case a year wouldn't kill me and I might even lose some weight. Well, years up and I'm getting ready to submit again. I have stayed away from these boards for a year now - so I'm anxious to hear what foolishness BCBS of Ill is up to... Amy