BCBS of IL

[Kgregory 8]

I have blue cross blue shield of il with the plan of ppo, i was just diagnosed with polycystic ovarian syndrome and put on a type 2 diabetes medicine. Will my insurance see that and instantly approve me. My bmi is 40 according to my endocrinologist and both my pcp and my endocrinologist recommended for weight loss surgery. Any situations similar to mine and your results??

Edited December 28, 2013 by Kgregory

[Fluffnomore 1,235]

It depends on your plan more than on the insurance company. I have BCBS/IL too, and was approved with no comorbidities at a BMI of 40. My husband, who has sleep apnea and is pre-diabetic, is currently appealing the denial. Arguably he "needs" the surgery more than I did. We're working on it. Good luck!

[LoryLosesXS 154]

I have never heard of an insurance automatically approving someone. Typically they require 6 months of a medically monitored diet record. However, it's worth a shot. Best wishes!

[Fluffnomore 1,235]

My plan did not require that. I had to have two visits with the NUT, one month apart, prior to approval. However, I also had several medically supervised programs in my past so maybe that counted. I really don't know.

This is why the insurance question is a hard one to answer on a forum like this.

[Kgregory 8]

I have bcbs of il and the plan is ppo?

[Fluffnomore 1,235]

It depends on what your employer has selected. I also have BCBS IL PPO but my plan could be completely different from yours.

[Memily 86]

You will have to do a psych eval and nutrition class. I had high blood pressure but not on meds and a BMI of 40 . I was approved on my first letter. I also have BCBS IL not sure if any thing is changing in 2014.Good luck!

[macman 603]

I have BCBS of ILL, PPO. They required a six month managed plan for approval. My BMI at start was 45, with 2 comorbidities. At submittal I had a BMI of 40. They approved me in 15 days. I think any WLS that is included in a medical plan is because it is deemed medically necessary.

I am not sure if you will get immediate approval. Check with the provider, see what they say. Does not hurt to ask.

[Fluffnomore 1,235]

You guys, even if we all have PPOs with the same insurance company it doesn't mean the requirements and or coverage are the same. Here's a quick primer on health insurance coverage:

http://obesitycoverage.com/insurance-and-costs/

I'm not trying to be difficult. I just know from talking with others who have different employers and have had the same surgery that the requirements are all over the place.

[KhadijahRose 66]

I had the same plan and was approved with no co-morbities and a BMI of 40+

[ginga126 5]

I have BCBS HMO and just finished my 6 months and have my appointment with the surgeon on Tuesday to submit for approval. I am nervous because I started at 40.3 the first time in July, but no preexisting conditions, other than achy hips when I run and some foot problems. I have done everything they asked and am worried I won't get approved because my BMI isn't "high enough". Has anyone else run into this problem? How long did it take for your approvals? Sorry for all the questions.....just very interested and nervous to get answers. I really hope I haven't gotten my hopes up