Anyone have BCBS Illinois?

[dlpfiff 0]

I have Blue Cross, Blue Shield of Illinois and wonder what others requirements were for approval. I have talked to the insurance company and have been dealing with the surgeon's office and getting different information. I believe they are on two different pages. When I spoke to the insurance company, they said I had to have three years of medical records showing I have been overweight and three months of either a doctor supervised diet or a weight loss program such as Weight Watchers. My surgeon's office is saying during the three years of medical records, I have to have discussed my weight with the doctor, which I did not do every year. I was not under that same impression. I thought I just had to have records showing my weight. I do know that the requirements for BCBS of Illinois seem to be a little less strict than other BCBS plans because they had initially told me I had to have other certain requirements done and then they found out that Illinois did not require those. I think we are all under different impressions about what is required. I am just curious as to what other people's requirements were. Thanks for any help you can give! Also, is it a possibility for me to tell the surgeon's office that I want them to submit the information they have and just see how it goes? I didn't know most surgeon's office would do it that way. I definitely have much more work to do! Thanks again.

[ngory07 22]

I have Blue Cross, Blue Shield of Illinois and wonder what others requirements were for approval. I have talked to the insurance company and have been dealing with the surgeon's office and getting different information. I believe they are on two different pages. When I spoke to the insurance company, they said I had to have three years of medical records showing I have been overweight and three months of either a doctor supervised diet or a weight loss program such as Weight Watchers. My surgeon's office is saying during the three years of medical records, I have to have discussed my weight with the doctor, which I did not do every year. I was not under that same impression. I thought I just had to have records showing my weight. I do know that the requirements for BCBS of Illinois seem to be a little less strict than other BCBS plans because they had initially told me I had to have other certain requirements done and then they found out that Illinois did not require those. I think we are all under different impressions about what is required. I am just curious as to what other people's requirements were. Thanks for any help you can give! Also, is it a possibility for me to tell the surgeon's office that I want them to submit the information they have and just see how it goes? I didn't know most surgeon's office would do it that way. I definitely have much more work to do! Thanks again.

I had my surgery on the 24th of Jan and I have BC/BS of IL. I needed a history of weight but I just had to fill out a paper stating my weights over the last couple of years. I wrote down the diets i had tried and how much I had lost., I did a 3 month supervised diet with my pcp. That turned into 6 months b/c my surgeons requirements. I had to see a therapist. Per my surgeons office I had to have a therapist evaluation, nutrition classes, dietician visits, and more. They have to approve you before they will submit for surgery. It only took 2 months to get my approval. I hope this helps!!!!!!!! Good luck!!!

[dlpfiff 0]

The only requirement of my surgeon's office is that you attend a support group meeting, which I did. BCBS IL requires a three month diet, which I actually did for five months. I have been overweight for most of my life so we could go back 25 years to prove I have been overweight and that has never changed. I don't know why they think weight has to be discussed each year. That is not the impression I was under from the insurance company. I know it was not discussed with my doctor each year. If I only went to the doctor a couple of times each year for a cough or something, why would it have been discussed? I am just frustrated right now. Is it possible to make the surgeon's office submit the paperwork even if they think I am wrong?

[ngory07 22]

The only requirement of my surgeon's office is that you attend a support group meeting, which I did. BCBS IL requires a three month diet, which I actually did for five months. I have been overweight for most of my life so we could go back 25 years to prove I have been overweight and that has never changed. I don't know why they think weight has to be discussed each year. That is not the impression I was under from the insurance company. I know it was not discussed with my doctor each year. If I only went to the doctor a couple of times each year for a cough or something, why would it have been discussed? I am just frustrated right now. Is it possible to make the surgeon's office submit the paperwork even if they think I am wrong?

I am sorry to hear that you are frustrated. Im not sure if you can do that but it never hurts to ask. I will say that for me I hadnt gone to a pcp in 5 years. I was in foster care and dont remember any of my doctors. I had virtually no history of talking with my doctor about my weight. I did see my ob/gyn for my pregnancy and they weigh you but that was not even reported to BC/BS. But I did have a great bariatric team who made sure everything was taken care of. They have an insurance specialist who actually makes sure that everything is being done and prints out what is required and what is covered. For example my nutrition visits were not included in my policy. I would really sit down with them and have them explain IN DETAIL what is needed and what they recommend.

[dlpfiff 0]

I decided to send an email to my insurance company. That way I will have their answer in writing and can show it to my surgeon's office. Hopefully I will hear back soon.

[NLWC.Christa 4]

You can find the BCBS-Illinois medical policy regarding bariatric surgery here: http://medicalpolicy.hcsc.net/medicalpolicy/home?ctype=POLICY&cat=Surgery&path=/templatedata/medpolicies/POLICY/data/SURGERY/SUR716.003_2010-07-01#hlink

Their requirements are:

BMI greater than 40

OR

BMI greater than 35 with two of the listed co-morbid conditions that have not responded to conservative medical treatment

Documented Three month supervised, comprehensive weight loss program which includes counseling in dietary, physical activity and behavioral changes.

Phsychological Evaluation and Clearance

Be sure to confirm with BCBS to make sure that your plan follows this medical policy. There are some plans managed by BCBS-Illinois that are self-funded and are able to set their own criteria for medical necessity.