Insurance Question BCBS IL ***-Chicago

[chachaheels 1]

Hello everyone, I have BCBS IL HMO. Just recently changed my medical group for logistical purposes. I went to the doctor and we discussed WLS. She stated that she would be unable to put in the referral because I had not been a member of the medical group for one year. I know my health insurance covers this surgery, but she said she cannot make a referral for one year. Has anyone ever heard of this. Is this true for all medical groups? I can change, but would like to find a group that does not have such strict policy. I am currently with Presence Medical Group.

[A. Stoot 85]

I have BCBSIL and was told the same, I had to have coverage for at least a year before being considered a candidate, and we'll one year later, I started the process again and my paperwork has been submitted waiting approval.

[chachaheels 1]

You had to have coverage with BCBS for one year or within that paticular medical group? I have had my insurance for almost two years just with a different medical group than I currently have.

[A. Stoot 85]

Coverage for one year with BCBS, but was told with any group. They did send me the requirements via email

[LKeys 12]

I have BCBS IL and when I reviewed the policy/requirements as well contacting them several times, they never told me of the one year waiting period. I am going to check tomorrow. Thanks for the information!

[A. Stoot 85]

Not a 1 year waiting period, I am sorry if I wasn't clear, but you have to have coverage for a year before they approve, and that also depends on the employer as well, still worth looking into and good luck

[Forsythia 882]

My understanding with BCBS IL is that you need to have had continuous coverage by them for one year, not that you have been going to the same doctor/clinic for a year. PPO doesn't care who you see as long as it is in network. H.M.O coverage might be pickier. I do know that none of the hospitals I was interested in affiliating with took the H.M.O. when I had it (I immediately switched to the PPO during the next open enrollment).

Edited because the nanny software thinks H.M.O. is dirty or something w/o periods or spaces.

Edited August 14, 2014 by Forsythia

[chubbychunkythickplump 19]

I have BCBS IL and the first time I looked into wls was four years ago and I did not have a PCP so the Bariatric Center I went to hooked me up with a Dr. that I had never seen before. So there definitely was not a year stipulation. It must just be the rule of that Medical Clinic. This time around I went with a different Bariatric Center who meets the "Blue Standard of Excellence". Hope all turns up in your favor, good luck!

[almosthome 91]

I had coverage with BCBS IL for less than half a year before obtaining surgical approval.