Approval from Blue Cross Blue Shield Illinois

I just wanted to come on and let everyone know that I received my approval today from Blue Cross Blue Shield of Illinois.... I want to post my situation, so that anyone pursuing this can see a positive outcome from BCBSIL.

I am doing to the Realize Gastric Banding Procedure. I have had a BMI around 40-48 over the last 5 years, have tried several diets over my lifetime. I don't really have any severe comorbities, except infertility issues and elevated blood pressure. I had about 12 months of documented Weigh****chers journals, but still had to do the 6 months of medically supervised diet/exercise. I started that process April 25, proceeded to go in May, June, July, Aug, and my final visit Sept 2nd. This was accepted as 6 months, although it was 6 visits, not 180 days. My Dr was great about making good notes in my chart, ie: vitals, weight, what I was doing, eating, exercising, what I should be doing, etc; and I went to the Dr specifically for this process. My information was submitted to BCBSIL in August to see if they would accept my Weigh****chers as part of my 6 months, and they replied that I needed one more month of notes, so that was completed Sept 2nd. That information was faxed on Friday, and I received my approval today, the following Wednesday. This process could not have gone smoother in my opinion. I think my very helpful Dr.'s office, Surgeon's office, and persistance were the key parts to this success.

I am having my surgery next Thursday, Sept 18th.

That is my story. Hopefully this can help someone going through the beginning stages of the whole process. Good luck to all of you.

Amy

I also have blbsil and am having a very difficult time getting approved for the surgery. My doctor has sent in pretty much everything that you have listed as needed and I am still getting denied. Have any advice on what I can do? please help

Did you have the bariatric rider on your insurance for them to approve your surgery? The reason why i am asking is? I have Anthem Key Care 20 PPO and it does not have the rider and they won't do the surgery without it but, i have heard in some cases that with 6 months of documentation and health concerns and written consent from dr's that it may be able to get approved? Good Luck with your Surgery!!!!!
Allison

Best of luck to you! 

Congratulations to you!!!  I know how excited you must be.. And your surgery date is not far away at all!!!!!

I too have BCBSIL.. and had a very hard time getting surgery approved.. In fact they denied me twice and I went to my employeer's appeal committee and they actually overturned BCBSIL denial!  I had surgery Dec 26, 07.  Had some minor complications (none with surgery but afterwards)  I actually had stress fractures in both my feet due to the increased walking!  But, today I am 95 lbs lighter and LOVE THE WAY I FEEL!!!

I just wanted to send you a quick note to make sure you follow all the doc's post op procedures!!  Good luck and keep in touch!!!  I will be thinking about you on the 18th!!!

Thank You for posting your experience. I have BCBS of Illinois, and have not yet submitted my info for pre-auth. I had to do 12 mos with a physician, nutrionist and a counselor (4 meetings each with the latter). I was unable to get a dr appt during June, but went first thing in July, so I am hoping that I will be approved anyways. I have heard that they can be difficult to deal with. I don't know what I am going to do if they don't approve it. I have invested so much money, time and effort on this it will be a huge dissappointment.

I am so happy for you, best of luck!
Jen