BCBS Illinois

[bufbills 316]

New here, and been wanting to sleeve for several years. Had some BMI issues with UHC several years ago and gave up. Had lost weight and couldn't meet their 5 year BMI requirement. Anyway, I'm with BCBS of Illinois now and am waiting for insurance verification so I can meet with a surgeon. Its been almost four weeks. Does anybody have experience with this insurance? Any advice on roadblocks or bumps i may encounter? Any chance I get this done this year?

Thanks, Joe

[Jerzeegrl 23]

@Bufbills I am also new here. I met with my surgeon last week and I also have BCBS Florida. Their MSLW waiting time for surgery is 6 months. So I won't be having my surgery until next year. Not sure if BCBS is the same across the board, but if it is unfortunately you won't be having your surgery this year. Your 6 months begins with the first appointment that you meet with your surgeon. I don't know about you, but I have a high deductible plan and this is the first year that I will have met my deductible, so my surgery would have been no cost to me out of pocket. But of course since it's next year I start all over again. It really sucks. I know this isn't the info you were hoping to hear, but I would make an appointment with your surgeon ASAP. Get that ball rolling. Good Luck!!

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[bufbills 316]

Thanks for the reply. Yea I'm getting mixed answers so lll have to just wait and see. I've looked at my policy and don't see anything about six months, but I could be missing something. I just hope to hear from the surgeons office soon. It's been about a month.

Thanks again!

[bufbills 316]

So I did get good news I think. My local hospital has become a BCBS center of excellence and I already got the ball rolling. The surgeon I've been waiting for is an hour and a half away. So glad I may be doing this 20 minutes from home and near my primary care doctor. Also, according to the insurance rep and the nurse who called from the hospital, BCBS had done away with the supervised 6 months, in many of their policies. I'm told if everything goes well, I could have this done in two to three months. I'll will update this thread as I know more for any who may be interested.

[Lanie992 168]

I have BCBSTX .... a BMI of 31.9 ( 5'5" and 192 lbs)... I got approved within 4 days.. With that said, I had other ailments -- high blood pressure, high cholesterol, high triglycerides and sleep apnea....(also on the verge of being diabetic)...

My doc had told me not to expect to get an approval/denial for another 30 days... but it only took them 4 days.

[bufbills 316]

So I'm told no 6 month requirement. I have appointments with the nutritionist and behavioral person on the 25th. The clock is now ticking, and I could have surgery in as soon as two months.

I'll continue to update.

[Lanie992 168]

1 minute ago, bufbills said:

So I'm told no 6 month requirement. I have appointments with the nutritionist and behavioral person on the 25th. The clock is now ticking, and I could have surgery in as soon as two months.

I'll continue to update.

Awesome news! All the requirements went much faster than I thought and I had the surgery soon after - I had to wait a month longer because of Covid though. Congratulations!

[AlwaysCruising 100]

Let me first say that the insurance company doesn’t really tell you very much. I know this because I am a provider who gets paid through insurance and I am a little too familiar with all of it ! For 500 people who have a policy from that insurance company X, 500 different policies will likely exist. That is the case for any insurance company. The insurance company isn’t the one deciding the policy provisions, it is instead the employer who contracts them for certain policies and they makes decisions about what they will offer.

That said, they are more than the typical number of policies written by Blue Cross Blue Shield of Illinois by large corporations like AT$T that seem to have the fast track option (3 mo vs 6 mo). You still have to meet all the requirements of the surgeon and the other requirements of the insurance company, but fast track means that you do three months of nutritional visits instead of six. Good luck!

Edited August 18, 2020 by AlwaysCruising

[kellicoley 36]

Hello,
Just wanted someone’s input on my situation. I was banded back in 2014. I lost about 85 lbs and was doing great. Until all of a sudden it caused me grief. A lot of pain, throwing up and reflux. After6+ years I’ve since gained about 40lbs and with all the problems I’ve incurred over the years my doc and I decided on a revision to the sleeve. Well, my insurance company, BCBSIL approved removal only. So, my doc is submitting a request for the revision to the sleeve. Has anyone had this happened to them? What are the odds of them not approving the sleeve? My worry is that I do not meet the BMI requirements to get the sleeve. If anyone can shed some light on this, it will be greatly appreciated. Thanks!