insurance requirements

[japeters 44]

Does anyone have blue cross of illinois and know what tbey require for surgery approval? I have UHC and am aware of tge laundry list of requirements to submit for approval but may be changing to BC of illinois and would like to know what they need. Many thanks!!

[CrazyCatLadyinLA 17]

BCBSIL covered my sleeve. They have 3 requirements: (1) BMI, either 40+ or 35+ with diagnosed comorbidity; (2) visit with nutritionist, and (3) psych evaluation. No monitored weight loss requirement like some other plans.

[kmorri 1,689]

no one can really answer that question. Insurance companies have many many different plans. The only way to truly know the requirements is to ask your insurance.....your doctor's office may also know (because they work with so many) but they will need to know your group number in addition to the name of your insurance company. Just because you know someone with the same insurance company as you doesn't mean the requirements will be the same........I retired from Blue Cross and now work from home for UHC,......Each company has an endless number of plans all with different requirements.

[kaitlynm 335]

Also your employer decides on the plans which may or may not include bariatric surgery.

[haleymarie 35]

What laundry list did Uhc have? That's my insurance, I started the process the last week of January and they submitted to insurance for approval earlier this week, I had no requirements besides what my hospital wanted. Uhc has been awesome and helpful...

[japeters 44]

Thank you everyone, i really appreciate the time you took to answer.

To haleymarie-my policy with UHC required the following before submitting to insurance for approval:

• at least 2 years documented obesity
• Approval/release letter from PCP
• Psych Evaluation
• Evaluation with Nutritionist
• EKG
• Pulmonary test
• proof of 6 month medically managed weight loss program
• BMI of 40 or BMI of 35 with documented comorbitities

Edited March 25, 2016 by japeters

[Brittneysue12345 18]

I have BCBS County Employee OHio

And I have a 6 months diet follow with nutritionalist

Nurse visit

Dietician

Psych evaluation

possible endoscopy (if needed)

Possible sleep study (if needed)

Of course any clearance from heart Doctor

Pulmonary function test (if needed)

Bmi 40 or above or 35 with comorbities