Approval: Healthcare Exchange Plan - BCBSIL

[MrsRP 36]

Update

I received a letter today from the insurance company. Denied. They say the surgeon didn't provide proof of nutritional counseling or behavior modification consults. Which I did both. So they didn't say anything about BMI or comorbidities. Tomorrow I'm stopping by with the letter so they can appeal.

[OutsideMatchInside 10,166]

You don't have listed that you saw a nutritionist on you post from January. Did that happen afterward?

My BMI was high and I had 2 co-morbidities.

At 35 BMI they might make you do more but on my plan, they didn't have BMI qualifications the qualifications were really vague, even my Dr office said they were vague.

[hopeful one 86]

I also have BCBSIL PPO I sure hope mine goes that quick, They told me they do not require 6 month supervised weight loss. I hope that's right. Good Luck to all.

[ocgirl15 667]

Great news. I have bcbsil through my employer and they were easy to work with. My doctor still had me do a 6month prep even though the insurance didn't require it. But that put my surgery in December. Since it was so late in the year my deductible and out of pocket max was meant (family plan.... I spent plenty of money on medical bills early in the year). Surgery and everything associated was covered 100% including the medicine they sent me home with. I was very please with the quality of my insurance.

[MrsRP 36]

Hello everyone

I've been MIA for a while. But today finally after 8 weeks of submitting my paperwork to the insurance company and being on the pre-op diet since last Monday: my surgery was approved Thursday! I'm scheduled for April 18th! So happy. Finally this is really happening! After going back and forth with my insurance company it's all good! It's like I still can't believe it!

Woohoo.

Edited April 10, 2016 by MrsRP

[LadyWarren 57]

Hello everyone

I've been MIA for a while. But today finally after 8 weeks of submitting my paperwork to the insurance company and being on the pre-op diet since last Monday: my surgery was approved Thursday! I'm scheduled for April 18th! So happy. Finally this is really happening! After going back and forth with my insurance company it's all good! It's like I still can't believe it!

Woohoo.

Congratulations!!! Yayyyy!!!

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[MrsRP 36]

Hello everyone

I've been MIA for a while. But today finally after 8 weeks of submitting my paperwork to the insurance company and being on the pre-op diet since last Monday: my surgery was approved Thursday! I'm scheduled for April 18th! So happy. Finally this is really happening! After going back and forth with my insurance company it's all good! It's like I still can't believe it!

Woohoo.

Congratulations!!! Yayyyy!!!

Sent from my iPhone using the BariatricPal App

Thank you so much

[Harsha 168]

That's exciting news!!

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[CrazyCatLadyinLA 17]

Yay! So glad BCBSIL finally came around. Good luck with surgery! [emoji106]

[MrsRP 36]

Yay! So glad BCBSIL finally came around. Good luck with surgery!

thank you so much!!!

[mobella 6]

Is the process different if you have BCBSIL HMO or is it pretty much the same as long as you get a referral from the PCP?

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[mobella 6]

That's supposed to say BCBSIL H. M. O.

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[OutsideMatchInside 10,166]

@@mobella

No idea about HMO. I didn't get a referral, I just went to see the Surgeon. The place my Dr was going to send me to wasn't even a place I could go with BCBS. They were clueless about the whole thing so I just took control. I didn't want to waste a bunch of time.

[mobella 6]

@@mobella

No idea about ***. I didn't get a referral, I just went to see the Surgeon. The place my Dr was going to send me to wasn't even a place I could go with BCBS. They were clueless about the whole thing so I just took control. I didn't want to waste a bunch of time.

Thanks for your response. I'm going for a consultation tomorrow. Hopefully it is not a long process. I called BCBSIL and they told me that their only requirement is the BMI >40 or BMI >35 with co-morbidities.

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[OutsideMatchInside 10,166]

The process with them is really fast. The drs make you jump through more hoops to qualify than they will.