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BCBS requirements

mommabear2311

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goaldigger33    39

goaldigger33
Posted

Yeah I live in Texas but have bcbs of IL and was able to be sleeved within about two months of looking into it. I didn't have to be monitored on a diet just a few small steps. Also depends on your job they sign up for specific groups of coverage with different requirements.

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I have BCBS of IL and like you said there are only two requirements, BMI over 40 and psych eval. But the surgeons office is claiming that I have to do a 6 month MSWL because I have to follow BCBS of VA's guidelines...since I live in VA...??? Makes no sense to me. I spoke with two different people at BCBS of IL and they assured me that I don't need to do the 6 month MSWL. So frustrated!

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kmorri    1,689

kmorri
Posted (edited)

Yeah I live in Texas but have bcbs of IL and was able to be sleeved within about two months of looking into it. I didn't have to be monitored on a diet just a few small steps. Also depends on your job they sign up for specific groups of coverage with different requirements.

Sent from my iPhone using the BariatricPal App

I have BCBS of IL and like you said there are only two requirements, BMI over 40 and psych eval. But the surgeons office is claiming that I have to do a 6 month MSWL because I have to follow BCBS of VA's guidelines...since I live in VA...??? Makes no sense to me. I spoke with two different people at BCBS of IL and they assured me that I don't need to do the 6 month MSWL. So frustrated!

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Do a conference call with both BCBS of IL and your surgeon's office so they can help explain to them how BlueCard works. (I retired from the BCBS system last Sept after 29 years). If just sounds like to me that the provider's office is confused on how BlueCard works. When you have BCBS in a state other than the one you live in.....the BCBS in the state where you live processes the claim, but they process the claim using the guidelines from the state where your policy is......So in your case, your surgeon will file their claim with BCBS of TX and they will contact BCBS of IL and ask how to process the claim ,,,,,,,this process is called BlueCard.

Hopefully a conference call will get it straightened out for you. Good luck!

Edited by kmorri

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goaldigger33    39

goaldigger33
Posted

Thank you for the information!!! I just got word from the doctors office that they will submit my paperwork to insurance after my psych eval in October! I think they're either confused or thought I wouldn't take it upon myself to check. Either way glad I got it straightened out. Thanks for the input!

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Racshelle    17

Racshelle
Posted

Hello PNWSleever,

I appreciate your post, I have BCBSIL through my husbands job at UPS. fGlad to hear BCBSIL does not require the 6 month diet. I wanted to know if BCBSIL require a five year weight documented history? I have my consultation to start the process on 9/29/16.

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PNWsleever    44

PNWsleever
Posted

Hello PNWSleever,

I appreciate your post, I have BCBSIL through my husbands job at UPS. fGlad to hear BCBSIL does not require the 6 month diet. I wanted to know if BCBSIL require a five year weight documented history? I have my consultation to start the process on 9/29/16.

Not at all. My surgeon got the insurance requirements and there were only 3. Easy peasy! From what I've heard bscs of IL is quick and painless when waiting for approval as well. I will keep you posted as I will be done with my surgeons requirements next week.

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Racshelle    17

Racshelle
Posted

September 26, 2016

PNWSleever,

Hello, I went to my PCP today to get a physical and to have my 8 month diet signed off on, just in case I am told that there is a six month diet even though I have heard many including yourself say that there is not one. I had an EKG, a chest x-ray, that was also part of the physical exam. I printed a letter of medical necessity and medical clearance and took it with me, the PCP kept that and said he had to have the office secretary re-type that and scan it into their system and asked me when I go to my appointment. I go for my initial consultation on Thursday, I am excited and ready to get the ball rolling.

Racshelle

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Leather'nLace    187

Leather'nLace
Posted

I live in WA State and have BcBs of IL. My BMI was 37, but I have sleep apnea. My entire process from my first call to my surgeon's office inquiring about information to my discharge a day after being sleeved was less than 2 months.

I had already met my deductible for the year, which is only $250, so my out of pocket expense was maybe $75 in various $15 copays for office visits. BCBSIL rocks.

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Melsyboo    43

Melsyboo
Posted

My BCBS in MA requires 6 months of non surgical weight reduction regimen in the 2 years prior to surgery. So if I was in WW or another program that counts. I made sure they specified it's NOT 6 month medically supervised

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kmorri    1,689

kmorri
Posted

I am covered under BCBS of Florida and didn't have any weight loss program requirements. From the time of my initial consult with the surgeon to my surgery day was a total of two months.

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PNWsleever    44

PNWsleever
Posted

September 26, 2016

PNWSleever,

Hello, I went to my PCP today to get a physical and to have my 8 month diet signed off on, just in case I am told that there is a six month diet even though I have heard many including yourself say that there is not one. I had an EKG, a chest x-ray, that was also part of the physical exam. I printed a letter of medical necessity and medical clearance and took it with me, the PCP kept that and said he had to have the office secretary re-type that and scan it into their system and asked me when I go to my appointment. I go for my initial consultation on Thursday, I am excited and ready to get the ball rolling.

Racshelle

Definitely great to be prepared! And look at you already checking off that requirements list! :) I have a consultation with a nutritionist tomorrow and Friday will be my psych eval. I have to attend a pre surgery education class before sending everything off to insurance so I will be scheduling that tomorrow.

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Racshelle    17

Racshelle
Posted

I am excited for you, soon you will be having your surgery. Two more days before my appointment. My PCP will have my letter of medical necessity/clearance ready for me to pick up by tomorrow, not later than Thursday.

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PNWsleever    44

PNWsleever
Posted

I am excited for you, soon you will be having your surgery. Two more days before my appointment. My PCP will have my letter of medical necessity/clearance ready for me to pick up by tomorrow, not later than Thursday.

I found out today the the nutritionist visits are 100% covered with no limit to how many times you see them by BCBS Il . It's nice to know that we will be able to have that resource free of charge.

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Go To Topic Listing PRE-Operation Weight Loss Surgery Q&A

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