BCBS IL PPO - Any suggestions?!?

sarahv · March 14, 2006

I have BCBS IL PPO through my husband's union. When I called the union benefits office - they gave me an unequivical "NO" when asked if weight loss surgery would be covered.

When I asked if it was specifically excluded - it is not. When I pushed as to why it wouldn't be covered, they himmmed and hawwwed and asked if they could call me back - I'm still waiting.

I then spoke to Bariatric treatment center who told me that they were in fact contracted w/ bcbsil and that they would cover it if I have 12 months of medically supervised weight loss.

What a joke. Cover it or don't cover it - but you're going to make me see a doctor once a month for a year before you pay for the surgery?!?!?

How much will twelve office visits plust the lab work for 1 year?!?

I'm just disgusted with them and frustrated that now I am either going to be a self pay patient or have to wait 12 months to have surgery.

Anyone out there been through something like this? or have any suggestions on how else to work it?!?

I don't want to go on another year being fat!!

Busy · March 14, 2006

I am seeing my PC every month for 6 months and the office visits are $50.00 a visit. Two more months to go, I had planned on being a banister befor my 47th BD in May but it does not look like it is going to happen. Thats OK, I will have the surgery and be recovered before the holidays. (Find your rainbows where you can)

PJ

sarahv · March 14, 2006

Well, speak/write of the devil. The union called me back and said again (with more feeling) that it was NOT covered. They haven't covered any WLS since 2000 - because it was so dangerous and there were so many people who 'got really sick' having the surgery.

I asked if it was a written exclusion and where I could see it in writing. She didn't know.

I also asked her why I spoke with a facility yesterday who said that they were contracted with bcbs il and stated that all I had to do was see my pcp for 12 months for weight loss.

Her response was that although they carry the bcbs name - they are privately funded by the union and whatever the union says - goes - and it's not covered.

So it's self pay for me I guess. Mexico here I come........

brneyezz · March 18, 2006

I have BC BS of Illinois through Sara Lee, my husband is in Teamsters. Look in your book to see if it's an exclusion, if it's not an exclusion then it a covered benefit. Call your plan administrator at the human resource dept.