BCBS of IL PPO

i live in GA and recently acquired bcbs of il ppo. i was wondering if anyone knew if they were going to continue to cover wls in 2006. i know that GA BCBS PPO will not cover wls after 2005. I am realizing that they require 12 months of supervized weight loss program. If I start now, of course, it will be 2006 before I can request the surgery.

I would bet you wont know untill they exclude it. I have BCBS IL ppo and I am currently on the 12 month diet. I will be pissed if they decide to exclude it before April of next year. Good Luck Mike

I have BCBS IL PPO and haven't heard a thing about them not covering WLS. I too will be very angry if this is excluded from all their policies . Get a copy of the Summary Plan Description for your new plan. That wil tell you exactly what is and what is not covered under your policy. I don't think they can unilaterally (I know I spelled that wrong) stop all coverage as of 1/1/06 but as policies come up for renewal they may put in new exclusions. So we will need to watch that. Regards, Ronna

If you go to their website www.bcbsil.com and click on providers, then click on blue review, in their september newsletter there is a big article about thier commitment to obesity and how they named some "prefered providers" for the WLS. Seems like they are pretty comitted to it, even have a special website they will refer providers to (that are not in their network I guess) and even plan to have an online approval process and a web-based "tool" for providers explaining the procedure, risks and benefits of WLS. SOunds great in theory, but you never know what is going to happen. Seems like they are not planning on doing away with anything though!!

Patty that's a good sign. Why would they go through all that trouble if they were going to stop coverage . Thanks for the link Regards, Ronna

Janie, Start the 12 month program today. I had to go through it and all the time there were rumors that they were going to discontinue it but they never did. They just keep upping the requirements. I was told they would discontinue it after 2004, but I got the RNY in July. Follow the requirements exactly. Get in an exercise program, see your physician monthly for weighins-not the nurse. Get in a nutritian program. Also be prepared. In my program, everyone with this insurance was denied the first time around. I think it is routine. They wanted me to try Optifast but Dr. said no. Good luck and be proactive. Sherry

thanks so much for all the info everyone. GA PPO did discontinue wls coverage as new policies were renewed throughout 2005 with the end result being no coverage by 2006 w/out a ryder(unless you were a self insured entity like Bellsouth or a university). I will definately look at the web site and as soon as my policy book comes in I will get everything in order. I already have an appointment w/ my Dr. this Thursday. The ball is rolling. thanks again.

Also, when you see your doctor each month, make sure the doctor puts down in detail EVERYTHING that you have tried to lose weight. The more detailed, the better. They tried to tell me that my records weren't detailed enough, until I got an attorney anyway. Good luck to you and I hope that you get your surgery. Keep fighting them and never give up! HUGS! Paula

thanks paula. i got on the bcbs website and printed info about what was needed including co-morbs they like to see and so forth. i am taking a copy to my Dr. and basically going to tell her what they need to see. I have a good relationship w/ her and I think she will do just what I ask. I hope so anyway. thanks