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Getting BCBSIL approval

BubblesOhSoSleeved

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BubblesOhSoSleeved    129

BubblesOhSoSleeved
Posted

Hey, I have a BMI of 46.6, and have been thinking about getting the sleeve done for 2 years now. I had my first initial consultation on Nov 17th...and was contacted yesterday by my case manager of my medical requirements. I've scheduled my psych and dietician evaluation for December 8th. I've will be scheduling my egd on Monday the 28th and have already gotten started on.the requirements needed by my insurance...my question is how long and how easy it it to get a first approval with BCBSIL??? My surgeon said if I can get my approval started on it would be able to have my surgery in December which is my goal because my deductible has already been met. Thank you all in advance!!!!

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YaneR321    63

YaneR321
Posted

I have the same insurane also. My BMI is 40.0 and I don't suffer from high blood pressure , diabetes or sleep apnea. I did everything required by BCBSIL and I was approved 1 week after doctors office submitted to them. My surgery is on December 8th =) good luck!

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ladygg1967    171

ladygg1967
Posted

No problem with coverage from this insurer.......they began covering WLS as of 1/2015 or 2016 (I forget which year is correct).......also, depending on how your coverage is set up, they may cover Cosmetic Surgery after Weight Loss......

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BubblesOhSoSleeved    129

BubblesOhSoSleeved
Posted

No problem with coverage from this insurer.......they began covering WLS as of 1/2015 or 2016 (I forget which year is correct).......also, depending on how your coverage is set up, they may cover Cosmetic Surgery after Weight Loss......

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Yeah they cover it with my moms group plan I'm just trying to get it done by the end of the year because my deductible has been met and my surgeon said the only set back would be my insurance but their requirements aren't difficult to obtain..so I'm hoping to send in my asking letter on the dec 9th so I can get this does either the week after or towards the end of decemeber...the only thing hindering me at this point is scheduling my EGD, after being cleared for that I should be able to apply for the coverage

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DillThePill    18

DillThePill
Posted

It took about 10 days for BCBSIL to approve me. Requires psych approval and that you have tried other diet plans and they haven't worked. But no specific requirement for 6 months or anything like that. I had to convince my surgeon's office of this. I live in Virginia and I guess the local BCBS is different. (My employer is in Chicago.) If I hadn't done my own homework they would have put me on the 6 month plan before submitting the claim.

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goaldigger33    39

goaldigger33
Posted

It took about 10 days for BCBSIL to approve me. Requires psych approval and that you have tried other diet plans and they haven't worked. But no specific requirement for 6 months or anything like that. I had to convince my surgeon's office of this. I live in Virginia and I guess the local BCBS is different. (My employer is in Chicago.) If I hadn't done my own homework they would have put me on the 6 month plan before submitting the claim.

I had a similar experience! My doctors office told me that insurance required 6 mos of MSWL but I called to confirm and they don't require it. Just a BMI over 40 and psych eval. I also live in VA and employer is in Chicago. I was recently approved for surgery and the whole process took a couple of months. Good luck!

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OutsideMatchInside    10,166

OutsideMatchInside
Posted

I was approved with BCBS IL 4 days after being submitted. Your BMI is high enough that if you have a surgeons office that knows how to submit. They can have you approved in a week or less.

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

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    • BeanitoDiego

      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

      BeanitoDiego

      Some days I feel like an infiltrator... I'm participating in society as a "thin" person. They have no idea that I haven't always been one of them! 🤣
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    • ChunkCat

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      Thank you everyone for your well wishes! I totally forgot I wrote an update here... I'm one week post op today. I gained 15 lbs in water weight overnight because they had to give me tons of fluids to bring my BP up after surgery! I stayed one night in the hospital. Everything has been fine except I seem to have picked up a bug while I was there and I've been running a low grade fever, coughing, and a sore throat. So I've been hydrating well and sleeping a ton. So far the Covid tests are negative.
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    • BeanitoDiego

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      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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    • Onedayatatime365

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