Approval: Healthcare Exchange Plan - BCBSIL

[OutsideMatchInside 10,166]

I am posting this here hoping that I can help someone else. I am self employed and live in Illinois. I purchased a plan on the healthcare exchange, BCBSIL PPO. When I selected a plan I purposely selected one that covered bariatric surgery.

Timeline

Informational Attendance 4/28

Appt with Surgeon 5/18

Appt with NUT and psychiatrist 6/8

Submitted to Insurance 6/10

Approved by insurance 6/22

Surgery Date 7/15

Surgery is covered 100% after meeting deductible, which was easy to meet doing the pre-op testing!

[FayBee 285]

That's great! I'm hoping mine goes that quickly! I have Blue care complete of Michigan and I was told they were easy about approving the surgery! So I'm crossing my fingers.

[Running2theSleeve 40]

I am posting this here hoping that I can help someone else. I am self employed and live in Illinois. I purchased a plan on the healthcare exchange, BCBSIL PPO. When I selected a plan I purposely selected one that covered bariatric surgery.

Timeline

Informational Attendance 4/28

Appt with Surgeon 5/18

Appt with NUT and psychiatrist 6/8

Submitted to Insurance 6/10

Approved by insurance 6/22

Surgery Date 7/15

Surgery is covered 100% after meeting deductible, which was easy to meet doing the pre-op testing!

That's awesome. I have BCBSIL PPO and the surgery is covered under my employers contract. It has to be deemed medically necessary! Well, I fall within the guidelines of what BCBSIL require >40 and I can see a Master's Degree or higher NUT to say I'm mentally stable and understand what's expected before, during and after surgery.

But ... My surgeon, through Cadence Health Bariatric Treatment Program, @ Central Dupage Hospital is having me to meet with my PCP for bloodwork and a letter stating there are no medical contraindications to surgery and a release to exercise, NUT, Pulmonologist, consult with an Exercise Specialist prior to surgery, Gastroenterologist eval or blood test to screen for H.pylori, an ECD and attend at least 1 support group. This along can take months.

Is all this needed to help with the approval from the insurance company?

[mommyfrog3 41]

This is all good to know. I have BCBSDE and they require 6 months of nutrition classes. Not to mention all the blood work, psychologist, nurse practitioner, cardiologist, pulmonary, endoscopy test and chest xray that is required by the Chrias group at Christiana hospital. Long process but hopefully sweet results!

Edited July 8, 2015 by mommyfrog3

[OutsideMatchInside 10,166]

I am not sure. I did not have to do all of those things. I had a new doctor so I had a full blood panel,xray,ekg, and met with a cardiologist. I have a flexible work schedule so that made all of the appointments easier. It seems like a lot of places drag it out. I am glad my doctor is moving it along

[Sharon1964 2,530]

.

Is all this needed to help with the approval from the insurance company?

No. Many if not all of those are requirements by your surgeon.

[OutsideMatchInside 10,166]

The only thing blue cross required was a weight history. Even the insurance verifier said it was vague

[mommyfrog3 41]

BCBSDE only requires 6 months of nutrition classes. The rest is required by my surgeon.

[Running2theSleeve 40]

I just realized that "Nut" was the nutritionist and not the psychologist/ psycharatrist = Nut Job. Lol

[Jersrose43 837]

I am posting this here hoping that I can help someone else. I am self employed and live in Illinois. I purchased a plan on the healthcare exchange, BCBSIL PPO. When I selected a plan I purposely selected one that covered bariatric surgery.

Timeline

Informational Attendance 4/28

Appt with Surgeon 5/18

Appt with NUT and psychiatrist 6/8

Submitted to Insurance 6/10

Approved by insurance 6/22

Surgery Date 7/15

Surgery is covered 100% after meeting deductible, which was easy to meet doing the pre-op testing!

That's awesome. I have BCBSIL PPO and the surgery is covered under my employers contract. It has to be deemed medically necessary! Well, I fall within the guidelines of what BCBSIL require >40 and I can see a Master's Degree or higher NUT to say I'm mentally stable and understand what's expected before, during and after surgery.

But ... My surgeon, through Cadence Health Bariatric Treatment Program, @ Central Dupage Hospital is having me to meet with my PCP for bloodwork and a letter stating there are no medical contraindications to surgery and a release to exercise, NUT, Pulmonologist, consult with an Exercise Specialist prior to surgery, Gastroenterologist eval or blood test to screen for H.pylori, an ECD and attend at least 1 support group. This along can take months.

Is all this needed to help with the approval from the insurance company?

These are all things your surgeon requires to ensure a successful outcome. This is major surgery and lifestyle change. You have a surgeon who wants to ensure success.

[lakenyagreen2986 5]

I have BCBSIL PPO + and I had my first appointment with the surgeon today. I called to see how much of my deductible was met for the year and was told 2339 of the 4000. So my question to those who have a deductible is will the surgeon proceed with pre operative testing if your deductible hasn't been met just yet ?

[OutsideMatchInside 10,166]

They don't know if your deductible is met or not and they don't care. If you haven't met it before pre-op testing, your pre-op testing will get you there.

Edited October 1, 2015 by OutsideMatchInside

[lakenyagreen2986 5]

Thank you!!

[newmebithebypass 713]

The tests my Surgeon requires is a chest X-ray a ekg and full blood work and a psych visit that's it

[MrsRP 36]

Hi

I have BCBSIL. I've met the surgeon 12/10, psych eval 12/10, meet the psych again 12/21 and meeting both surg and psych tomorrow 1/14. I have a BMI of 35 and osteoarthritis - but has never visit the doctor for that with this insurance.

I don't want to be rude, but I was just wondering what your BMI was before surgery and if you had co-morbilities. I called and my plan covers the surgery so I'm happy about that but I am extremely nervous about being approved.