Blue Cross & Blue Sheild of Illnois

[short1 2]

Does anyony out there have Blue Cross & Blue Sheild of Illnois? I spoke with them and they said the criteria was height, weight, Dr. orders, BMI, Thyriod test, psy. consult, and diets I have tried in the last year. This sounds too easy what is the trick? I have already completed their list, but do not want to get my hopes up too high.

[deb24 0]

I dont have Blue Cross of Illinois but my insurance sounds like they have similar guidlines. The trying diets part has to be documented by your doctor. Mine did anyway. He had to submit notes of the office visits that had weigh ins and showed that I had made a legitimate effort to lose. Mine was a six month period of time. Also check and see if they consider co-morbidities such as diabetes, high blood pressure and sleep apnea to put you into a qualifying catagory. I am having my surgery on 5/24. It sounds like you are blessed with good insurance and I feel very fortunate to have the coverage that will help me change my life. Good luck!

[jnkntrnk 0]

My company's group originates in IL, Anthem BCBS, but I am in Florida so I use the Nationwide Blue Card. Anyway they said the same thing (though I never heard Thyroid test). My papers were submitted to insurance last week. I agree it sounded too easy - my Bariatric center said plan on 3 wks to wait and hear. But they also said I could go ahead and get my PCP clearance, blood work, EKG and once rec'd they could set a surgery date, subject to insurance approval. I'll let you know as soon as I hear. FYI, yours may be diff, but my psych eval wasn't covered (selfpay for that). Also, the Ctr forewarned me that some of the expenses would be over allowed amounts since not in network for everything for this reason my Ctr requires prepay and then I would submit on my own for the Surgeons fee portion (hospital covered as in network). So even if covered it's possible to have some out of pocket (which will be worth it in the long run right?)

[tachlime 0]

I have BCBS of New Jersey. Just be prepared for a long wait, even after you've jumped through the hoops. They took 8 weeks to give the go ahead even though it was a slam dunk in terms of meeting the criteria. Maybe you won't have to wait too long. Also my psych evaluation was paid for. Sorry you couldn't find a surgeon/facilities in network.

[short1 2]

Good luck and thanks for the input.

[RN2be2008 0]

Hi, I am also new to this site. I have Blue Cross Blue Shield of IL, but the HMO version (HMO-IL) and this process has been surprisingly simple for me as of yet. I went to an informational session about 2 years ago so I didn't have to attend another. I went to the surgical consult on 4/13 and seen the dietition the same day, both approved me on the spot. Then three days later my Dr's office calls me to tell me the referrel for my psych consult was ready. I have been taking finals these past two weeks so I have been slacking off on scheduling my psych consult. Then a week ago my Dr's office calls me to let me know they are putting in the request for the approval for sugery and just today I got notice that I was approved by HMO-IL for the Lap Band tentative scheduled surgery date May 15, 07. They also told me that once I have all the preop tests completed I can schedule my surgery anytime on/after May 15th. I have to have an EKG, chest x-ray, pre-op labs, marshmellow barium swallow, and my psych consult then I am ready to go. SO far everything has been extremely fast and I can't believe I am so close to actually getting the Lap Band! Now I hope things go as swiftly for you as well but that is just my experience, yours could take much longer. If I get everything done asap then I should be able to have it done around the beginning of June, which means that it will have taken alittle over a month and a half from start to actual surgical date. Good Luck! -Mary

[Mike D 0]

I have BCBS of Il, and I waqsa just approved. However, I have a PPO through

the Carpenters union, so I had a different set of regulations.

I had to meet a pre-set BMI, have a list of failed diets, be 100 pounds overweight or greater, and have a pre-existing medical condition. I also had to see a cardiologist, Pulmanologist, and a phsyciatrist.

I was at first denied, so I had to re-weigh, write an appeal, and I got a written referral from all of my docs. I have since been approved.

Good Luck to you on your journey!!!!

Mike

[gina1107 0]

Hi

I have bcbs of Illinois and was banded 3/15/07. The whole process went incredibly smoothly and I was very pleased. As long as I followed the tests the surgeon wanted done and had them done at the hospital I was using they were great. So far I have not paid a penny and they have covered everything. WE called quite a few times to verify that they were going to cover it all and they told us that as long as my primary care physician referred it, they were a go. I just had a fill on Monday and they are covering those as well. I honestly can say they did not give me ONE problem.

[Vdander 0]

Hi! I have BC/BS of Illinois (HMO Illinois). It took them almost a month to approve me, but there was no problem. On 2/9/07 my surgeon submitted all the needed data to my PCP for submission to the insurance. In addition, I gave her a list of all diets I'd been on since 1973! I had surgery on 4/10/07 and the $21,000+ bill has been paid and there are no co-pays for anything. I'm 4'11 1/2" tall. My starting weight was 207 and I had 11 out of 13 co-morbidities. Currently, I am 192 and feeling great! I was supposed to have a total knee replacement, but after losing 10 pounds on the pre-op diet, I found I didn't need a cane anymore. Now, after losing another 5 pounds, I'm walking just fine and am going to hold off on the knee replacement for now. BC/BS may seem easy, but I think that when they see that most of a person's illnesses are weight-related, it just makes sense to let them have the surgery. They were spending about $1250 a month on me for my medications and sleep apnea machine + oxygen. I no longer have sleep apnea and several of my medication dosages have been cut in half. I feel just terrific!