Does anyone know how the long approval process of bcbs il with a ppo is? Is there extra criteria?

carolinagirl1991

I was at 40 with no co morbidities

That is my situation too...and you have already Been approved??

I am new here! I didn't know where to begin with this whole process! I called the bariatric center 8/21 and asked them if I could just 'stop by' to get weighed and measured. I figured I needed to know how close I was to meeting the requirements for bc/bs il before I got all excited. They said to come right in! So, I did. I just made the 40 bmi ! They scheduled an appointment for me to meet the surgeon for 9/19. got home, called a recommended pcp and got appointment for the next next 8/22. They weighed and measured ( actually just asked for my height), gave me the ekg,and confirmed the bmi! So relieved! They gave me the orders for the lab work and I will go Monday 8/25 to have blood drawn.

I am not sure what happens next, actually, but I will call the center to find out. Nutritionist? Psych eval?

Whatever! The ball is rolling and I am hopeful that bcbsil is as good to me as they seem to have been with so many of you!

Wow. I had more to say than I even knew. Pardon.

WELCOME!!!! It is definately exciting when you finally get the ball rolling...when you meet with the surgeon he/she will basically tell you about the surgery and answer any questions you may have...ASK QUESTIONS it is super important and they are happy to answer them...there are no dumb questions...soon after you should be able to do your psych eval and nutritionist visit...my office requires a physical therapy consult but I think that varies by office..after that you should be able to send in for approval once approved you meet with your surgeon again set your surgery dat do your post op testing and any pre op diets...I have heard BCBS IL is not a difficult to get approved since they changed their criteria as long as you meet the requirements..... It is a nerve wrecking process and it helps to be able to talk about it with people going through the process too...I have my psych and nutritionist on sept 4 and should be submitted that day...hopefully surgery end of sept fingers crossed!!! If you don't mind me asking what tests are you getting through your PCP?? GOOD LUCK!!! Keep us posted!!!!

Thank you for the welcome! To be clear, are you saying that I can't go ahead ad schedule a psych eval and nutrition eval on my own/before surgeon meeting on 9/19? I have to wait for him to tell me? I don't like waiting!! My pcp just ordered labs and did an EKG should there be something else?. I am also not sure who tells the pcp to send in a letter!

I think it varies by who you go to with my particular surgeon they have a "program" you follow so you have your initial consult and if he feels you are a good candidate he will have you meet for your psych and nutrition consult which they have in office and at some point you meet with a physical therapist across the street once you've completed all three steps they submit if your approved you got through a workshop and diet and pre op testing ekg etc...if you have to go out of office you can probably go ahead a schedule it. As for the testing there are a couple my surgeon requires but I'm sure you could ask your office... Usually you request the letter from the PCP but again if you have questions that can't be answered from someone on here you can call your surgeon they are usually very friendly I hope this helps :-)

The surgeon that I am seeing is a similar to being a "process" to help you through getting everything submitted. My thoughts are that it's to expedite the process. So here's what happened w/ me to get all paperwork in : first attend a seminar to learn abt the process and surgery options, then if all pans out you make an appt to meet w the surgeon, psych eval, exercise specialist, and nutritionist, in between or after that meeting I was given a packet of what was needed from me for the insurance coordinator to have in order to submit everything. That included a physical in the last 6 months, blood/lab work, any documentation that i had tried to lose weight and had been unsuccessful and medical records for the last two years showing a trend of high weight (the have me forms to give to all my docs for a release to have the records sent to them). Once complete it gets submitted

Hope that helps. Good luck!

I actually started a lot of things before seeing the surgeon. I had completed my referral, diet & sleep history, psych eval, physical with pap, some lab work, and attended all seminar classes. Those things you can complete on your own to speed up the process. Most bcbsil plans have no referrals so a lot of stuff you can just get done. If you want this to go fast do some of it yourself dont wait for them to "fit" you in to their appts that they have with fifty million other people.In my case there are only two bariatric surgeons and one was away for the whole summer. I refused to wait in line, I did my own ekg with my doc, add. bloodwork and met with a cardiologist. I also.went and did my own xrays. They wanted me to see the cardiologist 9/19. Oh I dont think so. Lol...Find out what needs to be done and if your pcp can do some of it, go to them if not either go with who the surgeon perfers or go online and find a specialist in network with bcbsil. The only thing I let them take care of was meeting with the dietician and endoscopy. My surgery date is 9/26 and to be honest my referral was sent on7/15 and I didnt meet with the surgeon until 7/29. The only thing that made it go by slower was I am very young and he wanted to see how well I did on the preop diet. Down 12pds in about a month, see him for a follow up on Tuesday. Call BCBSIL ask questions about referrals, your GROUP specific guidelines and/or BCBSIL guidelines, in network specialist and your cost.

Hope this helps :-)

Wow! Thanks everyone for all the helpful info! I will def call the center in the AM and see what the requirements are! I will take care of it FAST! I have lab work done first thing in the morning so I can tick that off the list. NEXT!! Good luck to all of you.????????

Glad ur working on getting it done quickly! Just a recommendation if you haven't gotten the list of required bloodwork needed you may want to ask for what the surgeon requires - I was surprised to see the long list they were collecting samples for.

Has anyone been approved without a letter of medical necessity from their PCP...I know this sounds childish but I'm slightly afraid to go and ask for one and her give me the whole lecture on eating better and exercising...like hello?!?! You don't think I've already tried that?! And then do something where she messes up my chances of getting approved like putting me on a diet where I can't get approved until I've completed it or something!!! Any advice here?!?

Has anyone been approved without a letter of medical necessity from their PCP...I know this sounds childish but I'm slightly afraid to go and ask for one and her give me the whole lecture on eating better and exercising...like hello?!?! You don't think I've already tried that?! And then do something where she messes up my chances of getting approved like putting me on a diet where I can't get approved until I've completed it or something!!! Any advice here?!?

I have because my BMI is 42...

You can go to another provider if you think that one will screw you over. I know I did. I did not like the first provider I had and she had my bmi all wrong and didn't want to give me a referral even though I qualified. I just dropped her and went to another provider. Depending on your insurance-group they may have specific guidelines for you to follow when sending in your predetermination such aS a letter of medical necessity. I know BCBS-IL standard guidelines for Bariatric Surgery is a letter of medical necessity usually done by the surgeon and the coordinator you are going to go see for the surgery and all the program requirements. It is not usually your pcp that does it.

The only thing you need from your PCP is a referral with your BMI from this year, thats it, you're pretty much done with him/her unless you want to do some of the requirements such as xray, labs, ekg, or etc with them to get some stuff done quicker

Also, the letter of medical necessity doesn't really state much other than diets you may have tried, your bmi, your age, and what the doctor thinks will help with your obesity, which is the surgery, doesn't state much and also your co-morbidities. Sorry I kept forgetting stuff. I work for BCBS-IL and also some other states so if you need help let me know