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BCBS of IL....Any advice appeiciated :-)

carolinagirl1991

By carolinagirl1991, in Insurance & Financing

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carolinagirl1991    6

carolinagirl1991
Posted

Having my first appointment this Tuesday...BMI of 40 with sleep apnea...I have BCBS of IL through my dads work which i believe is PPO.... I am really concerned about approval...I have read several threads and nothing is consistent....surgeons office said they no longer require six month supervised diet which i am postivs of but do they require a letter of medical necessity and weight history!? I have three years weight history about 35 but I moved to North Carolina And I cannot manage to get a hold of my medical records from my previous doctor. Any advice???

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Kasey Parker    31

Kasey Parker
Posted

I have BCBS of NC and if its like IL, there is no longer a supervise diet. I read the regulations when I signed into the website and it doesn't say anything about have weight history or anything. I just have to have the BMI, see the nutritionist and psychiatrist. When I made my seminar appt the woman said BCBS was the GOOD insurance because they don't require the paperwork the others do. But then again that's for the NC version. I suggest calling or going on their website and it should be in the documentson what they require for each type.

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carolinagirl1991    6

carolinagirl1991
Posted

Thank you kasey...I have read the online policy and it does not mention the diet or a letter or weight history I'm just worrying myself by reading

Forums about others experience....it is a nerve wrecking process...thank you for you advise I appreciate it :-)

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Juciilyps:)    67

Juciilyps:)
Posted

I think its all up to the employers ..i have Bcbs of Texas..and i have an exclusion on any WLS..so its best to call insurance company before u spend $$$$ for office visits ..

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newnikki13    0

newnikki13
Posted

I have BCBS IL and my insurance checklist included 1) nutritional assessment, 2) psych assessment and 3) any documentation of weight loss attempts. I finished all paperwork on July 29th and received my approval letter last week. I hope this helps!

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newnikki13    0

newnikki13
Posted

Hi...I think the delay was due solely to the office staff. There was one form missing that was actually just surgical clearance. I was called on the 15 th of July and went to my PCP on the 16 th and it was faxed to the office the same day. My insurance company said that once they received this letter , I would have my decision in 24 hrs. I called ins company on the 30th of July and they had just received it the day before. Afterwards, all I was told by ins. company was that it was pending. I really did not think I would be approved, but I knew in my heart that this was my last hope. Now that I have a date, I am nervous but excited. OCT. 16th!!!

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carolinagirl1991    6

carolinagirl1991
Posted

Wow congrats to you!! Yeah I had my appointment on August 20 and on September 4 the I fulfilled all the office requirements...I am STILL waiting on submission by my office and they told me it was because the psych eval could take up to three weeks to get it back I was shocked!! I was shooting for an Oct 3rd date but the are now booked up for the endoscopy and final surgeon consult until mid oct I'm a little agitated but I keep reminding myself that it's all worth it!!! Good luck on your surgery and best of luck with your new happy life!!!

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carolinagirl1991    6

carolinagirl1991
Posted

I have another question for anyone who can help. I noticed on the note faxed to my PCP something about 12 month office notes. I'm not sure what this would be for. I have BCBSIL PPO and I DO NOT have any required diet documentation that needs to be sent in. Did anyone else encounter this?? I have all my lab results and my letter of medical necessity from my PCP and a three year weight history. It said something about five years on the sheet but I have only been at that doctor for three years and cannot get a dhold of my doctor in Ohio for any additional documentation. When I talked to the operator about my policy she said nothing about weight history. Anyone have any problems or encounter any of this going through their process?!?!

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      Soooo I am coming to a realization
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        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

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