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My BCBSIL story



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After thinking about it long and hard, I finally started my journey for revision from band to sleeve in June. I finished all my requirements which was a nutritionist and nut evaluation in July and after getting clearance from various Dr's about my results of blood, eco, fitness and EGD my paperwork was finally submitted to BCBSIL by my Dr office in August. I did have to constantly check the status with my Dr office and BCBS to make sure all was submitted and received, good thing to do because once BCBS received my paperwork, I was approved but it took days for the letter to get generated by the predetermination dept. I was told that it only takes 1 day for the letter to be sent out, so whatever the delay was, it led to really good customer service at BCBS. My rep was upset that I didn't get my letter the day it was supposed to be generated and she made sure to check daily for me and kept reminding the predetermination dept to send my letter ASAP. Today was finally that day, my Dr office received their copy and called me 1 hour after....my surgery is set for September 18.

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Congrats! I hope everything goes extremely well for you!

Summer

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Thank you Summer Rain

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BCBS Federal Employee Plan is the best insurance I have ever had.....ever. One thing that I like about it is the availability of a case manager to help handle processess and procedures. Any time I have some lingering health problem, like my knee replacements, stroke and now weight loss surgery, I accept the help of a case manager. She also checks up on me from time to time to see how I am doing. The other thing I like about it besides excellent coverage is that for my sleeve, BCBS approved a five day stay in the hospital if needed.

Any delays I had were from the bariaric clinic's side. When my packet was submitted, BCBS approved it in two days. I found out because when I called the doctor's office to see if it was submitted, I was told yes, but that they would not know anything for a couple of weeks because the insurance coodinator was on vacation. So.....I called my case manager at BCBS and she said it was already approved. The case manager mailed me a letter of confirmation whicj I then faxed to the surgeon's office. As soon as they received it, I was given a surgey date the same day. I am not as patient as I used to be and have become way more pro-active about my healthcare.

Good for you that you are staying on top of things. I wish you good luck and good health.

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Thanks Miss Mac

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....my surgery is set for September 18.

Good luck today! I hope everything goes well and you have a speedy recovery!

Summer

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Can I ask you guys what the name of your plan was for BCBS? And did you have to do a 3 or 6 month supervised diet before the surgery? Thanks

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Can I ask you guys what the name of your plan was for BCBS? And did you have to do a 3 or 6 month supervised diet before the surgery? Thanks

I have the PPO HSA plan, no supervised diet required

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I'm not sure what my BCBS IL plan was, but I had a 6 month obligation to a diet. I do know I had a PPO. I've heard that the 6 month thing has been changed since I completed my program. Call them up and ask!

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A Soot, The PPO HSA plan you have; is it a gold, silver, platinum plan? Can I ask what the specific name of it is? Thanks!

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      Iʻm roughly 6 weeks post-op this morning and have begun to feel like a normal human, with a normal human body again. I started introducing solid foods and pill forms of medications/supplements a couple of weeks ago and it's really amazing to eat meals with my family again, despite the fact that my portions are so much smaller than theirs. 
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    • BeanitoDiego

      Oh yeah, something I wanted to rant about, a billing dispute that cropped up 3 months ago.
      Surgery was in August of 2023. A bill shows up for over $7,000 in January. WTF? I asks myself. I know that I jumped through all of the insurance hoops and verified this and triple checked that, as did the surgeon's office. All was set, and I paid all of the known costs before surgery.
      A looong story short, is that an assistant surgeon that was in the process of accepting money from my insurance company touched me while I was under anesthesia. That is what the bill was for. But hey, guess what? Some federal legislation was enacted last year to help patients out when they cannot consent to being touched by someone out of their insurance network. These types of bills fall under something called, "surprise billing," and you don't have to put up with it.
      https://www.cms.gov/nosurprises
      I had to make a lot of phone calls to both the surgeon's office and the insurance company and explain my rights and what the maximum out of pocket costs were that I could be liable for. Also had to remind them that it isn't my place to be taking care of all of this and that I was going to escalate things if they could not play nice with one another.
      Quick ending is that I don't have to pay that $7,000+. Advocate, advocate, advocate for yourself no matter how long it takes and learn more about this law if you are ever hit with a surprise bill.
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    • BeanitoDiego

      Still purging all of the larger clothing. This morning, a shirt that I ADORED wearing ended up on top. Hard to let it go, but it was also hard to let go of those habits that also no longer serve my highest good. Onward and upward!
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