BCBS of IL or Aetna of AZ?

[Thx4dinner 10]

I'm currently in open enrollment through my work and I can switch to Aetna of AZ from the BCBS of IL plan I'm currently on. I'm not sure how any of this works I seems as though the requirements are less extensive in the Aetna of AZ plan although more expensive. The BCBS of IL plan I can self refer to a specialist but Aetna I have to get a referral from my PCP. This applies for the surgeon right?

[RickM 1,752]

Each company should have a policy bulletin somewhere on their website that will spell out all of the requirements and limitations for WLS. If you already have a surgeon picked out, check with their insurance coordinator to see which company is easier to work with or has more generous coverage.

Also, make sure that whichever plan you choose does indeed cover WLS - Aetna and BCBS will both cover WLS in general, but your employer may choose plans from them that exclude that benefit, so watch out for that trap.

[TagUrIt 17]

I'm currently in open enrollment through my work and I can switch to Aetna of AZ from the BCBS of IL plan I'm currently on. I'm not sure how any of this works I seems as though the requirements are less extensive in the Aetna of AZ plan although more expensive. The BCBS of IL plan I can self refer to a specialist but Aetna I have to get a referral from my PCP. This applies for the surgeon right?today

I actually have BCBS-IL and was just approved today. The requirements are provided here http://www.medicalpolicy.hcsc.net/medicalpolicy/activePolicyPage?lid=ia2d1toe&corpBrand=Boeing&corpEntCd=IL1. Aetna is offered from my job. And here is there policy  http://www.aetna.com/cpb/medical/data/100_199/0157.html. The BIGGEST difference without consideration to what your deductible will be is that Aetna requires six months medically supervised program. BCBS Illinois does not. I basically had three things: BMI 35 or greater, psyche eval, and nutrition consult. My surgeon wanted en EGD and stress test but those things could be done at any time prior to surgery. Hope that helps!

[Thx4dinner 10]

I'm currently in open enrollment through my work and I can switch to Aetna of AZ from the BCBS of IL plan I'm currently on. I'm not sure how any of this works I seems as though the requirements are less extensive in the Aetna of AZ plan although more expensive. The BCBS of IL plan I can self refer to a specialist but Aetna I have to get a referral from my PCP. This applies for the surgeon right?today

I actually have BCBS-IL and was just approved today. The requirements are provided here http://www.medicalpolicy.hcsc.net/medicalpolicy/activePolicyPage?lid=ia2d1toe&corpBrand=Boeing&corpEntCd=IL1. Aetna is offered from my job. And here is there policy http://www.aetna.com/cpb/medical/data/100_199/0157.html. The BIGGEST difference without consideration to what your deductible will be is that Aetna requires six months medically supervised program. BCBS Illinois does not. I basically had three things: BMI 35 or greater, psyche eval, and nutrition consult. My surgeon wanted en EGD and stress test but those things could be done at any time prior to surgery. Hope that helps!

Thank you!! It definitely does! The only problem I'm finding is finding the doctors for the past 5 years. Did you have that problem??

[TagUrIt 17]

My primary care physician & surgeon are in the same hospital system so my records from my PCP were accessible. Any Gyn records??

[MrsRP 36]

Hi

I have BCBSIL too. I have BMI 35. Did my psych eval and I'm good for that. I have met the Nut yet. I have osteoarthritis and gerd but haven't for official diagnosis for that with the insurance.

Did you get approve for surgery? Did you have any comorbidities?

I meet my surgeon and the psych tomorrow to see what we can do to get approval.

I'm so nervous.

[careya123 260]

I have BCBS Illinois and the requirements seem reasonable. In other words, no 3-6 month diet! Although I'm on the low end of the BMI scale, I have 3 severe co-morbidities. (I have a friend at the same weight, and she is perfectly healthy. Weird.)

[Thx4dinner 10]

I ended up switching to Aetna which was a very bad idea because once I met with my surgeon, I found out that my plan has a specific bariatric exclusion which made me so mad because now I'm paying more for a plan that does nothing. Luckily, I'm still able to be covered under my dads UHC plan which is going to cover my surgery but I do have to do the 6 month diet. But I will get there!

[LadyWarren 57]

I ended up switching to Aetna which was a very bad idea because once I met with my surgeon, I found out that my plan has a specific bariatric exclusion which made me so mad because now I'm paying more for a plan that does nothing. Luckily, I'm still able to be covered under my dads UHC plan which is going to cover my surgery but I do have to do the 6 month diet. But I will get there!

I'm sorry to hear that, I thought you checked your particular medical policy before you switched. BCBSIL is good with little requirements. You may be able to drop your Aetna insurance if you can't use it.. if you have proof of other medical insurance. Good luck!

Sent from my SM-N900V using Tapatalk

[MrsRP 36]

I ended up switching to Aetna which was a very bad idea because once I met with my surgeon, I found out that my plan has a specific bariatric exclusion which made me so mad because now I'm paying more for a plan that does nothing. Luckily, I'm still able to be covered under my dads UHC plan which is going to cover my surgery but I do have to do the 6 month diet. But I will get there!

Oh no. At least you will be able to do it in the near future. 6 months go by very fast! My surgeon said that BCBSIL is the best insurance he has seen in terms of requirements. I know he wanted to submit this week but I'm not sure they did. So we will see how 'good' they actually are.

Good luck on your journey and know we are all here to support each other! Let's do this! ????

Edited January 24, 2016 by MrsRP