Question:
claim just sent to bcbs of Il for lapband what to expect?

I have blue cross blue shield of Illinois and my claim was just sent today for lap band what should i expect as far as length of wait for an answer is it true they usually always deny? I am about to drive myself crazy any input is appreciated thanks    — kristie1970 (posted on September 11, 2008)

September 11, 2008
First of all you need to call BCBS of IL and make sure they have your pre-determination packet. If they don't have it, call your surgeons office and ask them to resend it. Mine was faxed and it took my insurance company 3 weeks to put it in their system! From the time they receive my package it took them 4 days to approve me. I called them on 8/7 to see if they had an answer for me yet and they said it was determined on 8/4 that I met the criteria for surgery. I have BCBS of AL and they seemed to be on top of things. I hope all goes well for you too!!
   — Melissa D.

September 11, 2008
I work for an insurance company (not BCBS) but benefits are very specific for bariatric surgery and are based from employer to employer...not BCBS across the board. Basically meaning...I could have BC and you could have BC...but with different employers....my employer might cover mine...but your employer might not cover yours and vice versa. I would check w/ either your HR dept. or w/ your BCBS benefit department to determine what your bariatric surgery benefit is. That way you will know up front. Always remember....unless it is a specific exclusion from your benefit plan....you always have the right to appeal your healthplans decision. I highly recommend that. Also....healthplans have specific time lines that pertain to approval/denial for non urgent referrals. That means that as long as all the information is obtained and you have the benefit and you meet criteria for the surgery...it can be approved in just a few business days. The problems comes when documentation is not complete or more information is needed. My suggestion is to call to make sure info was received and is complete. If it is not complete...you can get w/ your surgeon and make sure the appropriate info is provided. That will cut down on the time frame. Good luck to you!
   — jamiedaugherty

September 11, 2008
I also have this insurance. I have one more month to go before I can submit my remaining month of diet with my pcp. I had to have 6 months of supervised diet with pcp; and a physc eval and a letter from my doctor, I hope it goes quickly I will send in my remaining info on Oct 1. Like you I am very nervous. I haven't done good at all on my diet. I have only lost 3 pounds. Hope this doesn't keep them from approving.
   — pugsley101

September 12, 2008
Hi there! I have BCBS IL PPO and I just had a lap-band placed over a previous gastric bypass and they covered it. Initially they denied me...It took approx 3 weeks to get the denial letter. However, my surgeon's office got ObesityLaw involved and I was approved on the second try and that took about 2-3 weeks to get the approval for. Mine was a "revision", so I'm not sure if the criteria was different than what would be needed for the initial surgery.
   — Binxalways