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Approval: Healthcare Exchange Plan - BCBSIL

OutsideMatchInside

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MrsRP    36

MrsRP
Posted

Update

I received a letter today from the insurance company. Denied. They say the surgeon didn't provide proof of nutritional counseling or behavior modification consults. Which I did both. So they didn't say anything about BMI or comorbidities. Tomorrow I'm stopping by with the letter so they can appeal.

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OutsideMatchInside    10,166

OutsideMatchInside
Posted

You don't have listed that you saw a nutritionist on you post from January. Did that happen afterward?

My BMI was high and I had 2 co-morbidities.

At 35 BMI they might make you do more but on my plan, they didn't have BMI qualifications the qualifications were really vague, even my Dr office said they were vague.

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hopeful one    86

hopeful one
Posted

I also have BCBSIL PPO I sure hope mine goes that quick, They told me they do not require 6 month supervised weight loss. I hope that's right. Good Luck to all.

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ocgirl15    667

ocgirl15
Posted

Great news. I have bcbsil through my employer and they were easy to work with. My doctor still had me do a 6month prep even though the insurance didn't require it. But that put my surgery in December. Since it was so late in the year my deductible and out of pocket max was meant (family plan.... I spent plenty of money on medical bills early in the year). Surgery and everything associated was covered 100% including the medicine they sent me home with. I was very please with the quality of my insurance.

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MrsRP    36

MrsRP
Posted (edited)

Hello everyone

I've been MIA for a while. But today finally after 8 weeks of submitting my paperwork to the insurance company and being on the pre-op diet since last Monday: my surgery was approved Thursday! I'm scheduled for April 18th! So happy. Finally this is really happening! After going back and forth with my insurance company it's all good! It's like I still can't believe it!

Woohoo.

Edited by MrsRP

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LadyWarren    57

LadyWarren
Posted

Hello everyone

I've been MIA for a while. But today finally after 8 weeks of submitting my paperwork to the insurance company and being on the pre-op diet since last Monday: my surgery was approved Thursday! I'm scheduled for April 18th! So happy. Finally this is really happening! After going back and forth with my insurance company it's all good! It's like I still can't believe it!

Woohoo.

Congratulations!!! Yayyyy!!!

Sent from my iPhone using the BariatricPal App

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MrsRP    36

MrsRP
Posted

Hello everyone

I've been MIA for a while. But today finally after 8 weeks of submitting my paperwork to the insurance company and being on the pre-op diet since last Monday: my surgery was approved Thursday! I'm scheduled for April 18th! So happy. Finally this is really happening! After going back and forth with my insurance company it's all good! It's like I still can't believe it!

Woohoo.

Congratulations!!! Yayyyy!!!

Sent from my iPhone using the BariatricPal App

Thank you so much

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Harsha    168

Harsha
Posted

That's exciting news!!

Sent from my SM-G925V using the BariatricPal App

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OutsideMatchInside    10,166

OutsideMatchInside
Posted

@@mobella

No idea about HMO. I didn't get a referral, I just went to see the Surgeon. The place my Dr was going to send me to wasn't even a place I could go with BCBS. They were clueless about the whole thing so I just took control. I didn't want to waste a bunch of time.

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mobella    6

mobella
Posted

@@mobella

No idea about ***. I didn't get a referral, I just went to see the Surgeon. The place my Dr was going to send me to wasn't even a place I could go with BCBS. They were clueless about the whole thing so I just took control. I didn't want to waste a bunch of time.

Thanks for your response. I'm going for a consultation tomorrow. Hopefully it is not a long process. I called BCBSIL and they told me that their only requirement is the BMI >40 or BMI >35 with co-morbidities.

Sent from my SM-N930T using the BariatricPal App

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OutsideMatchInside    10,166

OutsideMatchInside
Posted

The process with them is really fast. The drs make you jump through more hoops to qualify than they will.

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