Hello everyone, I have BCBS IL HMO. Just recently changed my medical group for logistical purposes. I went to the doctor and we discussed WLS. She stated that she would be unable to put in the referral because I had not been a member of the medical group for one year. I know my health insurance covers this surgery, but she said she cannot make a referral for one year. Has anyone ever heard of this. Is this true for all medical groups? I can change, but would like to find a group that does not have such strict policy. I am currently with Presence Medical Group.

I have BCBSIL and was told the same, I had to have coverage for at least a year before being considered a candidate, and we'll one year later, I started the process again and my paperwork has been submitted waiting approval.

You had to have coverage with BCBS for one year or within that paticular medical group? I have had my insurance for almost two years just with a different medical group than I currently have.

Coverage for one year with BCBS, but was told with any group. They did send me the requirements via email

I have BCBS IL and when I reviewed the policy/requirements as well contacting them several times, they never told me of the one year waiting period. I am going to check tomorrow. Thanks for the information!

Not a 1 year waiting period, I am sorry if I wasn't clear, but you have to have coverage for a year before they approve, and that also depends on the employer as well, still worth looking into and good luck

My understanding with BCBS IL is that you need to have had continuous coverage by them for one year, not that you have been going to the same doctor/clinic for a year. PPO doesn't care who you see as long as it is in network. H.M.O coverage might be pickier. I do know that none of the hospitals I was interested in affiliating with took the H.M.O. when I had it (I immediately switched to the PPO during the next open enrollment).

Edited because the nanny software thinks H.M.O. is dirty or something w/o periods or spaces.

Edited August 14, 201412 yr by Forsythia

I have BCBS IL and the first time I looked into wls was four years ago and I did not have a PCP so the Bariatric Center I went to hooked me up with a Dr. that I had never seen before. So there definitely was not a year stipulation. It must just be the rule of that Medical Clinic. This time around I went with a different Bariatric Center who meets the "Blue Standard of Excellence". Hope all turns up in your favor, good luck!

I had coverage with BCBS IL for less than half a year before obtaining surgical approval.