Bcbsil h m o

[NikkiB1 1]

Hi I'm currently in process of supervised diet and they been playing games with saying it is up to my surgeon how long it would be then the diet supervised girl is like you have 12 months of this when I just got done doing a year of calorie counting by myself, I pay 300 a month for this insurance just for the wls and I called bcbs and they act clueless to it all even talking to the bariatic people of bcbs I told the girl at the Kane a Center in Hoffman estates that it was bs when I just got off from a over a year of trying myself to just be told oh well do it again for another year.. I pay 300 a month for this bs and I can't even get anything I need done.. If anyone has any advice or insite all is welcomed

[HopeandAgony 566]

Hi Nikki. When you elect a H M O that is the nature of the plan. Your Dr controls all aspects of your Healthcare.

I too had BCBS IL H M O. My employer offered 2 plans and the PPO didn't cover wls so I didn't have a choice.

My primary care Dr made me complete a monitored weight loss program before they'd even give me a referral to the surgeon. I had to have 4 months of monthly weigh ins (3 months) with a lose of 6 lbs and no gains. When I finished that I got my referral to the surgeon.

When I saw the surgeon I had to get medical clearance from a pulmonary Dr (with testing), a cardiologist (with testing), and a psychologist (with testing). Once I passed all of those I got my blood work done, had to attend a handful of classes with the surgeons office and then my surgery was scheduled.

My first appointment with my primary care was early April 2015. My first appointment with my surgeon was early August. My surgery was November 16th 2015. Almost 8 full months.

Your only option to attempt to shorten the time frame you've been given is to change your medical group (thru the insurance company) see a new primary care, and in essence start over with the process. I really believe though that would only save you a handful of months.

With H M O the insurance company let's the Dr lead the way. That really is the design of the plan.

I will say the 8 months gave me time to do a lot of research and soul searching. At the end of the day I was thankful I had the opportunity to read every single up and every single down that I could get my hands on. I know it's hard to wait, but the wait is worth it.

Good luck on your journey. Hang in there.

[NikkiB1 1]

So my main dr controls the length of the supervised diet?

[HopeandAgony 566]

No. It's a collaborative effort pre determined by the medical group (both your primary and your surgeon). The example I provided was my medical groups practice. I was only trying to show you that your 12 month program probably isn't too far off from what most H M O groups would require.

The 12 months you just did, was it Dr supervised? Did you have Dr appointments during that time where weight loss was recorded? If so you might ask that those appointments be considered. If they weren't, unfortunately the Dr's have no way to know you did what you say and most good surgeons want to provide this surgery to people who show commitment, and that is why they want to monitor you for a while. They need to see you can make the changes to support the surgery.

I know it's frustrating. I wanted to void my waiting period too but I really did learn a lot in that time frame.

Edited September 2, 2016 by HopeandAgony