H.E.L.P (BCBS of Illinois PPO)

Can someone please assist me? I have BCBS of IL PPO and they are giving me the hardest time regarding the 12month Dr. monitored diets. Is there any way to get around/through this. My OB/GYN and PCP have sent over their medical records in which I know weight was discussed, but nothing seem to be working. I have completed ALL of the other requirements. To make matters worse, I'm working with a December 31st deadline. Any suggestions will be greatly appreciated.

I too have BCBSPPO of Illinois and am going through the 12 months. I have talked with several people on the Illinois message board and they all say no one is getting around that. As a matter of fact it used to just be 6 months and ealier this year they changed it to 12 mths. You can go the the BCBS of Illinois website and look at their policy and it will tell you exactly what they require. If you need a direct link let me know and I will find it for you. Sorry.

Thanks for your response Janie.... I've checked the website and it does say 12months, which is a real bummer. I'm really fustrated right now and want to give up. My husband suggested that we get a loan in March/April 2006 to pay for the WLS if all else fails but we have 3 children and I pay a substantial amount for coverage as it is. I've been with BCBS of IL since 1999 and have never had to have any type of surgery, just the normal preventative care for my family. It just doesn't seem fair. To add insult to injury, rates are increasing for 2006. I just thought it would be so much easier with the letters of reccomendation from my PCP, OB/GYN, & Surgeon. Please see my other post as I am thinking about changing my plan for 2006 and any suggestions you can give me on the listed plans will be appreciated. My only concern with changing plans is there may be a waiting period or I have to start the process over from the beginning.

I don't have much info on the others besides hearsay. I have heard United Healthcare is not covering but I don't know that for a fact or maybe it was just certain employees were not offering that as part of the package. Who knows? Going to that fair in a few weeks is your best bet. As far as a 12 month waiting period, it is my understanding that as long as you have had coverage prior to you new insurance, a pre-existing period cannot enforced on you. If you change plans and have already started the 12 month Dr. supervised period you should not have to start over as it does not matter which insurance you started with. You just have to have the 12 months. Funny thing about pre-existing periods... BCBS IL requires 5 years of documented obesity but if you have a pre-existing cluase you technically couldn't have the WLS for another 12 months because you have been obese. WTF.

Thanks Janie, I will keep you posted on the outcome.

Hello, Not sure if this will hel*****t....I too needed a 12 month diet history, my PCP (Primary doc) has been with me for at least 10 years and we were able to get all the documentation from all the visits over a year...now I had BCBS of GA, but I would imagine that they would work roughly the same.....they require a good amount of paper work (different letters from drs and whatnot) I was diabetic previous to surgery and my dr had sent me to see the nutritionist for the diabetes, this was also helpful and BCBS accepted it...might be worth a try