BCBS Illinois

dlpfiff · February 21, 2011

My info was submitted to BCBS Illinois on Wednesday, 2/16. I called today and it had been received. The rep I spoke to got all the info together and sent it to review while I was on the phone with her. She said it takes up to 14 business days for an answer. I will let you all know how long it takes for me so people may have an idea for the future if they also have BCBS Illlinois. After approval, my surgeon says surgery will be scheduled for two weeks later! Woo Hoo!

SunnyinSD · February 21, 2011

I'm going to be submitting to BCBS of Illinois in the next 2 weeks. Please let me know how it goes for you! Also, a question - was your medically-supervised diet 3 visits each a month apart, or 3 months total? I'm worried because even though I will have done 3 visit each a month apart, I will have submitted to insurance after only 2 months (i.e. I went for my first visit on January 6th, the second visit on February 11th and the third visit will be on March 10th - but January to March is only 2 months).

Thanks, and good luck to you!!

dlpfiff · February 21, 2011

I think your three visits will be fine. They are still three visits each a month apart. Three months is really only two months period of time. I don't think you have anything to worry about. I actually did five doctors visits because I used to have a different insurance that required six visits but now only have the one insurance, which only requires the three. Another thing for you to consider is that if you did anything like Weight Watchers or Jenny Craig within the past 24 months, you can also submit that information. So, all in all, I submitted five doctor visits and two months of Weight Watchers books. I don't think you should have a problem but if you are worried and have any other diet plan info, be sure to include it, just in case!

Good Luck!

Deb

gfawcetti · February 22, 2011

Good luck.....I am excited to see what they say. I have BCBS of IL too & am having the same concerns. If you don't mind me asking what is your BMI?? Mine was 40.3 at my first weigh in at WW & that is what they are supposed to be using for approval, right?? Cuz I have lost a couple pounds in the supervised diet so my current BMI is 38.6 so I hope I haven't messed something up!! I am just worried I have gotten my hopes up for nothing... ya know?

Hope you hear soon!!

Glenna

dlpfiff · February 22, 2011

Unfortunately, my BMI is around 50 so I shouldn't have any problems there. It is my understanding that they use your starting BMI. Here is the info they sent to me a couple of weeks ago. This is specific for my policy and am not sure if they are all the same:

Thank you for your inquiry. Medical record documentation of active participation in a clinically-supervised, non-surgical program of weight reduction for at least 3 months occurring within the twenty-four (24) months prior to the proposed surgery and preferably unaffiliated with the bariatric surgery program. [NOTE: The initial BMI at the beginning of a weight reduction program will be the "qualifying" BMI used to meet the BMI criteria for the definition of morbid obesity used in this policy.]

A program will be considered appropriate if it includes the following components:

1. Nutritional therapy, which may include medical nutrition therapy such as a very low calorie diet such as MediFast or Optifast OR a recognized commercial diet-based weight loss program such as Weight Watchers, Jenny Craig, etc.

2. Behavior modification or behavioral health interventions.

3. Counseling and instruction on exercise and increased physical activity

4. Ongoing support for lifestyle changes to make and maintain appropriate choices that will reduce health risk factors and improve overall health.

SunnyinSD · February 22, 2011

My starting BMI was 41 or 42 (I can't remember), but now I'm under 39. (I'm really rocking this pre-op diet) But I'm not concerned that I'm under 40 because the requirements for surgery specifically state that the starting BMI is what will be used when going in for approval.

myrori · February 22, 2011

I have bcbs il, but my husbands employer also has a say in the review. I did not have to do the 6 months diet before hand and once I jumped through all the hoops for the surgeon it and they submitted my papers I was ready to go in two weeks!

dlpfiff · February 24, 2011

Well, I have good news and bad news. It only took them one day to decide whether or not they were going to cover the surgery (went to review Monday and had decided by Tuesday). The bad news is...they denied me. The reason was that they didn't feel my doctor and I discussed exercise enough during my doctor supervised diet plan. This doesn't even make sense to me since they say they accept Weight Watchers and Jenny Craig diets, which are eating plans. They would have no way of knowing if you discussed exercise with your Weight Watcher leader or not since you just turn in your weight book for proof of the plan. I am frustrated and think their reasoning makes no sense but.......my surgeon wants me to do the diet again and make sure we specifically discuss both diet and exercise in depth so that is what I will do. It's actually three visits, which is only two months and I can live with that. It's been so long already, what's another two months??!?!?! I can do it.

SunnyinSD · February 24, 2011

I'm so sorry!!! That REALLY sucks! I will have to ensure that my doctor fully documents the exercise portion of the diet. Maybe it would help if your doctor resubmitted your diet info to include exercise. And they agreed to take only the 3 visits, not 3 months??! I'm over the moon about that little tidbit.

Please note that as of March 15th, BCBS of IL will be requiring a 6 months weight loss program, not 3 months. So it's probably a good idea to try to have your doctor resubmit your old diet paperwork with some exercise stuff added in (I'm sure you talked about exercise, he may just have overlooked documenting it)

dlpfiff · February 24, 2011

I just called my insurance company to check on this change. I definitely do not want to have to do a six month diet if I don't have to. They assured me that there is no change planned as of right now. She said that if a change is being made, they give them several months notice and they have not received anything saying anything like that. She said that maybe it is a new requirement of your policy but from what she could see on mine, there was not going to be a change! Hopefully she is correct.

dlpfiff · February 25, 2011

I have called twice now to check on the change to a six month diet. I did verify that it does say this on their website and it says it is changing 3/15/11. I called twice and have been assured both times that it is not correct and there is not going to be any changes made. Fingers crossed that they are correct!

AwesomeSleeve · February 26, 2011

I really hope this is not true. I have my last appointment with the nutritionist on April 1 and my three month supervised plan will be complete. If they change it, I'll have to do an additional three months because I'll miss the change by two weeks. What a bummer.

NLWC.Christa · February 27, 2011

Wow! I really hope they are not making the change back to six months. I speak to BCBSIL at least 3-5 times a week and it has never been mentioned that the policy would be changing, though i can tell you that the reps are the last ones to know when policy changes are handed down. (When I submitted my surgery, they tried to deny based on the fact that my 3 month non-surgical weight loss was not "physician supervised" even though the policy hasn't said "physician supervised" since 2008. lol) As for the weight watchers thing, I submitted copies of all of my weekly meeting booklets that discussed exercise, that seemed to work.

I'll be calling first thing Monday to see what I can find out!

Also, I routinely submit predetermination packets to BCBS. I always fax on Monday or Tuesday and I ALWAYS have an answer by Thursday or Friday of the same week. They always say they take 14 days, but I've never had one go longer than a week.

NLWC.Christa · February 27, 2011

I really hope this is not true. I have my last appointment with the nutritionist on April 1 and my three month supervised plan will be complete. If they change it, I'll have to do an additional three months because I'll miss the change by two weeks. What a bummer.

Perhaps ask your doctor to submit all of your information just prior to March 15. At least that way you have it on record and a review number assigned prior to the change date (if it changes) and then they would just have to submit your final progress note when you finish on April 1. It is worth a shot and could save you three months if the policy does change.

AwesomeSleeve · February 27, 2011

Hi NLWC Christa. Thanks for the information. My original packet was submitted on January 4th but they needed additional information on the weight loss and since I had completed WW for 5 months they requested more detailed information. I did not have the booklets that they gave out each week and I did not keep a journal so that's when it was decided that I would do a program again for three months. I'm hoping that since my information is already in the system and they are just requesting additional information, I'll be able to get by. I'd appreciate any information you can find out. Thanks a bunch.