Bcbs Il ppo what has been your process?

[Rucamama 104]

Quick update - my patient advocate is already putting my info in for insurance approval! Still have some pre-op appts to complete in September, but it would be great to get approved already. It's been just under a month since I first went to their free seminar to them putting in for my insurance approval. Seems like it's going really fast!

I'm freaking excited I got my insurance approval today! I didn't even realize my Doc office sent my info yet! I'm so glad I have that part over so I don't stress over getting denied.

[karen_marie 220]

On 10/5/2017 at 4:38 PM, Rucamama said:

I'm freaking excited I got my insurance approval today! I didn't even realize my Doc office sent my info yet! I'm so glad I have that part over so I don't stress over getting denied.

Awesome!! Mine took longer than expected (I guess BCBS of IL was behind on approving a lot of surgeries), but I got mine too last week and an getting my pre-op tests done at the hospital tomorrow. Surgery is on 10/27 and I can't wait! Started my 2wk liquid liver shrinking diet yesterday, and so far so good lol

[TheNewMrsR 249]

Bummer! Too bad BCBS doesn't have their medical policies match from state to state [emoji20]

They don't even match employer to employer in the same state. Companies can opt out of specific procedures and treatments.

Sent from my XT1635-01 using BariatricPal mobile app

[A1220M 101]

On 8/17/2017 at 10:31 AM, karen_marie said:

I've got BCBS of IL, PPO through work. I also did the cost estimate on the BCBS website, and it basically said I only had to pay my max out of pocket for the procedure. I then checked my policy and confirmed that gastric bypass is covered. When I reached out to my insurance, these are the requirements they gave me in order for them to review my submission for approval. You'll notice that BCBS IL did away with the 6mo required diet back in Feb. 2012 (I pulled the current BCBS of IL medical policy on bariatric surgery and it notes when changes were made at the end of the policy). I've attached the policy PDF with the predetermination information at the beginning.

"For a member to be considered eligible for benefit coverage of bariatric surgery to treat morbid obesity, the
member must meet the following two criteria:

1. Diagnosis of morbid obesity, defined as a:
   • Body mass index (BMI) equal to or greater than 40 kg/meter (* see guidelines below for BMI calculation); OR
   • BMI equal to or greater than 35kg/meters with at least one (1) of the following comorbid conditions related to obesity that have not responded to maximum medical management and that are generally expected to be reversed or improved by bariatric treatment:
     • Hypertension, OR
     • Dyslipidemia, OR
     • Diabetes mellitus, OR
     • Coronary heart disease, OR
     • sleep apnea, OR
     • Osteoarthritis; AND
2. Documentation from the requesting surgical program that:
   • Growth is completed (generally, growth is considered completed by 18 years of age); AND
   • Documentation from the surgeon attesting that the patient has been educated in and understands the postoperative regimen, which should include ALL of the following components:
     • Nutrition program, which may include a very low calorie diet or a recognized commercial diet-based weight loss program; AND
     • Behavior modification or behavioral health interventions; AND
     • Counseling and instruction on exercise and increased physical activity; AND
     • Ongoing support for lifestyle changes to make and maintain appropriate choices that will reduce health risk factors and improve overall health; AND
     • Patient has completed an evaluation by a licensed professional counselor, psychologist or psychiatrist within the 12 months preceding the request for surgery. This evaluation should document:
       • The absence of significant psychopathology that would hinder the ability of an individual to understand the procedure and comply with medical/surgical recommendations, AND
       • The absence of any psychological comorbidity that could contribute to weight mismanagement or a diagnosed eating disorder, AND
       • The patient's willingness to comply with preoperative and postoperative treatment plans."

I'm sure your surgeon has an entire program already put together to meet pretty much all of these requirements. My surgeon is Dr. Jonathan Wallace at Suburban Surgical out in Hoffman Estates, and their practice is a pretty well-oiled machine at this point. I just had my initial consult with Dr. Wallace on 8/9, and I've already had my insurance confirmed by them and multiple appointments set up (first set of labs, psych eval, and two required nutrition classes).

Hope this helps! I'm just starting my journey but I've done a TON of research already, if you can't tell

Current BCBS IL medical policy on bariatric surgery as of 3.15.17.pdf

I know this is an old thread with old info ut THANK YOU for this! Extremely helpful!!

[Michele 2021 25]

I am with BCBS i had my first consult appt In October and had to go thru several months of dietician visits a psych evaluation, an EGD to make sure There were no issues etc. Once I finished all the required appts they did submitted my paperwork..it took 2 weeks for approval and my surgery was scheduled for April 28th so it wasn’t a quick process...I’d plan on a timeframe of 4-6 months out for getting WLS which I think is a good thing as it gives you time to better prepare....

[dmason99 0]

I have BCBS, and I need all that stuff... the nutritionist, Endo, Card, psyc, bld wrk, sleep study, etc. Everything has been scheduled between March 31st and June 23rd. End of June, they want me to get my blood work done. I’m hoping this is only a 3-4mo process. I’d like to have my surgery in July of this year. I’m hopeful...

[ClarkKent 35]

Just curious what BCBS you guys have? I have BCBS from Texas and all I need according to them is Nutr, psyc, and doctors approval.