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Insurance Question BCBS IL ***-Chicago



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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.

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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.

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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.

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

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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!

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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

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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 by Forsythia

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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!

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

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    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
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      1. LeighaTR

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    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        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.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

      Officially here for a long time, not just a good time💪
      · 0 replies
      1. This update has no replies.
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