Bcbsil Approved!

[Kat Crowder 34]

I just got approved today! Yay!

I talked about this in another thread - I received a denial letter last week, primarily because the insurance coordinator for my surgeon's office hadn't submitted sufficient information (no information from my PCP except a letter, no information from my pulmonologist (and sleep apnea is my most advanced comorbidity), not enough info in the surgeon's attestation, etc.). I ended up talking to my PCP to get additional case information, sent medical records from my old doctor from 2001-2005 showing the comorbidities from back then, got my pulmonologist to supply a letter and my records, all to the surgeon's office. They faxed over ALL the records yesterday (I figured they'd go through and send the relevant ones, but no), and they set up a peer-to-peer talk between my surgeon and the insurance folks today, and voila, it's approved! The letter implied that an appeal needed to be filed, but when I called on Monday to ask if the additional documentation should be sent in an appeal, they said, oh, no, don't do that - an appeal can take up to 60 days or more, just send the additional documentation on the same case file. That wasn't clear at all. I bet it's really the peer-to-peer call that makes the difference to the doctors making the decisions - they don't want the explanation from Some Peon Without An MD and if they can get the information they need from a telephone conversation with someone with the letters after their name that they respect, they're willing to approve it.

Another weird thing about my office is that they've refused to send me my "next steps" for after insurance approval until they had the approval in hand. So I get to find out tomorrow what I have left to do and what my timeline might be. I hope we can look at surgery dates. I believe I have an additional nutrition class, a GI exam, and some sort of preop diet to follow, but my pulmonologist has cleared me for surgery.

I'm glad this is really happening!

-Kat, who needs to work on a ticker for her sig at some point. :-D

[mariamaria1070 21]

Congrats! I've recently moved to IL in Jan and I also have BCBS. I've been trying to get a referral from my PCP to a local Dr. that does the sleeve but apparently I live in a very small town & I can't seem to find one ;-( If you have any suggestions or advice I'd really appreciate it! I really want to get this on it's way and I know it's a long road so I'm trying to start down it asap! Hope to hear from you soon! Again, congrats! ~Maria

[iwannabslim 67]

Congrats! I jus went through the same thing! They told me that they needed more information, but the letter implied it was a denial letter. I wonder why they send the request on the same letterhead as the denials?

[chitowngirl 884]

@ Maria what type of policy do you have? Ppo or ***? I work in a hospital and know insurance like the back of my hand. I can really help you navigate the system, I just need a little more information. Also what area are you in? What's the nearest big city?

[mariamaria1070 21]

@chitowngirl- thanks for the reply! honestly, I don't know, lol... I work for a hospital too, just started in Jan. But unfortunately there is no Dr. thru them so I have to go to a ppo dr. which I found in Champaign at the Illinois Bariatric Center. They will cover like 70%, he approved under my insurance. I live in Bourbonnais, IL and I guess Chicago is the biggest city near me. Does this help? Thanks again! Appreicate your help!!

[chitowngirl 884]

If you have a ppo, the choice is really yours. I had my procedure done @ university of Chicago, I loved their program as it is very established I also liked the fact that the bariatric nurse herself had the sleeve. They have dietitians on call at all times. Northwestern hospital, and university of Illinois has a pretty good program. Check out their webssites. I know university of Chicago is a bariatric center of excellence. So I would make sure they a center of excellence. When I was at my meetings I met a few women from pretty far out as far as 2-3 hours. Also at UofC if you have a bmi over 40 you get a private room, which is nice if you need someone to stay over night with you. Feel free to ask me any questions.

[Afyna 2]

I got a referral from my PCP two weeks ago. I have BCBS-IL too. How long should I wait to hear back from the insurance co. I have a BMI of 43.

[Kat Crowder 34]

I got a referral from my PCP two weeks ago. I have BCBS-IL too. How long should I wait to hear back from the insurance co. I have a BMI of 43.

Afyna, it never hurts to call the insurance company and check. A lot of people, including me, have had a response come quickly after calling to follow up. Whether that's coincidence or not, I don't know.

Good luck!