Bcbsil And Gastric Sleeve Surgery Question

[indi1 66]

I mentioned this yesterday in a post, but the more I think about it the more its driving me crazy. Does anyone who has BCBSIL every dealt with the surgeons office saying they cant do the surgery because they are not a blue distinction site? I was told that yesterday, but also I called BCBS to confirm myself and they say that is not true. Specifically, my policy says nothing about this requirement per the BCBSIL rep. In researching the blue distinction centers on BCBSIL website, I found the statement below with indicates its voluntary for the member. I just don't know how to get the surgeons office and BCBSIL on the same page. One thing is confirmed- the surgeon is in the network, so that is good.

"BCBSIL member participation is voluntary. Members whose benefit plan includes coverage for bariatric surgery will be advised of the Blue Distinction Centers for Bariatric Surgery; however, depending upon the member's benefit design, the member may be able to choose other contracted facilities without penalty. The member must complete a medical weight management program and satisfy all other criteria in the medical policy regarding Surgery for Morbid Obesity before bariatric surgery can be considered. When using a Blue Distinction Center for Bariatric Surgery, members should confirm that the surgeon is part of the contracting network by calling Customer Service. Members will not receive in-network benefits for the services of surgeons or other providers who are not in the contracted provider network of the member's health plan."

[100%Sleeved 148]

_{Hi Indi,}

_{I had this very same problem. I was actually going to be banded and was going to a doctor for 6 months. I started my pre-op diet and it was going well. On the 9th day of pre-op I received a call from the surgeon's rep stating BCBSIL will NOT cover the hospital because it was not recognized as a center of excellence (Blue Distinction). I was soooo upset so I called the insurance company and asked them why are they doing this to me? Was it not enough you told me that I only had to see a doctor for 3 months and then in mid stream you changed it to 6 months and now this? Oh boy I was going off. So I got this nice supervisor name Sherene. She told me if my doctor can perform the lapband at another hospital which carries this distinction then I can move forward. She also stated that the employer set it up that way because they wanted the best. At this point I could care less about the best, I just wanted my surgery. Finally after coming to terms with their policy I found Dr. Rehnke who took me in right away after he heard my story. I went to his seminar, and I realized he did lapband, sleeve, and bypass. Up until this point I thought I wanted to be banded, but after this seminar, I realized I wanted to be sleeved. I was suppose to be banded on the 10th by another doctor but I ended up sleeved by Dr Rehnke on 11/15/11 5 days later. This mix up was the best thing that could have ever happened to me. The blue distinction is for your good. It only means the surgeon and the hospital are experts in this field and they have done thousands of these surgeries and they are willing to put everything on the line to give you the best care. I'm so happy. I'm 2 wks out and I'm down 25 lbs. I wish you the best and hope you find a good hospital.}

[indi1 66]

Thanks for your encouragement!

[hadouni 301]

I'm in CA and have BCBS and they've been horrible - They have information posted on their website that is wrong and their customer service people quoted the wrong information to me too. I called to find out if the surgeon/hospital I wanted to use was covered and they told me no (person and website) and pointed me to three different hospitals as options (one of which doesn't do WLS any more). I went to one of the places they directed me to and was seen, only to find out that surgeon/hospital was NOT an option for me and that the ONLY local option for me was the place they originally told me I couldn't go!

I called my employer's benefits office to get them to confirm things for me. I think things are back on track, or I hope!

[Soon2BMiniMommy 92]

I did mine under BCBSIL, and just like Sleeved Realtor above, I was going to do the band, then they changed from a 3-month to a 6-month program in my second month, then found out my first surgeon wasn't preferred. Went to another doc who does all three (Center of Excellence) and through that process, 'found' the sleeve.

I have never looked back and have never one complained about my husband's insurance. My insurance through my work, and most everybody else's, doesn't cover bariatric surgery at all, so I am very, very, very blessed and I am grateful every day that my 'mishap' happened, or I would currently be suffering with a band AND having to pay 40% for it! I have many friends who are so jealous and upset they can't go on this wonderful journey with me....

BCBSIL does want you to use a Center of Excellence exactly for the reasons stated above...those surgeons have to pass rigorous reviews and qualifications so you know they are VERY experienced and have to continually prove low, low, low complication rates.

I know, very well, how frustrating it is to have to jump through hoops, have things changed, have to change surgeons when you like the one you had and got attached to, and just generally have to wait when you want this major life change just to START, already. But this is a major decision, and sometimes it's good when fate puts on the brakes for you. I am THE most impatient, impulsive person I know (check out my blog!) but now I am glad I had to wait and had to experience what I did...it allowed me more time to research, and to learn, and to be on this site, and get to where I am at now.

It will come, just have patience and be grateful you're covered at all

Then come on here to vent and have us help you through it and bring you down to earth with support, love and understanding!

[indi1 66]

I am very graceful that I am covered, no doubt about that. And you are correct in the reasons they prefer a blue distinction center. I'm just worried about my job and finances. And I really am grateful for the "hoops" now. As I posted a few minutes ago in anthother thread, it was confirmed yesterday that I have hemochromatosis (too much Iron in my system) and I would not have found that out if I had not gone through all this and have begun treatments. It could have been much worse it I had found out later. Thanks for the encouragement!

[100%Sleeved 148]

Hi Indi,

I just read on another tread you are approved. I so happy for you. Please keep us posted.

[indi1 66]

Hi Sleeved- Yes, I was approved, after being denied. Instead of 6 visits to the PCP, they wanted 7 to make 6 complete months. So I did one more and I am approved. Then I was looking at a date the first of the year, so I excepted I would lose the benefit of not having to pay my entire out of pocket since I was now looking at January. DH told me he would help me out with the money, so I was going to accept that as a late Christmas present. Well, I found out yesterday that now they are backed up until March. Now I am back to timing issues at work. I can only say that I am amazed at how many people are having this surgery and there is such a waiting list. Anyway, I am very happy I am approved. I am also considering looking at another surgeon that may not be so booked up. I may call about that tomorrow. I just don't know if that means I will have to resubmit to insurance or not.

And you were just congratulating me and got all this...sorry Just in a "mood". I know it sounds like I am not grateful, but I really am.

[100%Sleeved 148]

It's ok. I truly understand. If you need to vent just feel free to mssg me. We're all in this together. BTW if you wait until next year, will you still have the same coverage?

[indi1 66]

Well the insurance plan from my standpoint remains the same, I cannot speak to the agreement between the insurance company and our employer. BCBS told me to call back "closer" to the new year to see if my employers plan had changed. She said the approval would never expire, even next year, but I don't trust that.