Anyone have BCBS of IL but live in Virginia?

[goaldigger33 39]

I posted on this topic a couple of days ago. Apologies for the duplicative post if you've already read it.

So, I have BCBS of IL but currently reside in Virginia. My surgeons office told me that insurance requires 6 month MSWL. I spoke with BCBS of IL (twice) and they assured me that there is no 6 month MSWL requirement. I then spoke to the surgeons office again and told them what insurance told me and the response was "we have to follow the BCBS of Virginia guidelines". Ummm...what?! Why?! It makes no sense to me. I don't have BCBS of VA!

Has anyone had a similar experience? I'm so annoyed with these people. Why would I have to follow VA guidelines when my insurance doesn't require it?! Sigh...

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[sey1008 43]

I have BCBS IL PPO. I live in Texas. Often they try to file under TX, or don't look at the fact that mine is union insurance. That said, I do NOT have any supervised diet. Just the surgeon's requirements (Psych, nutrition class, EGD). I have had trouble in the past with them not filing correctly, but most offices file IL and I have zero issues. I'm not sure about Virginia laws, but I know several people with out of state plans that don't have issue.

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[OutsideMatchInside 10,166]

BCBSIL doesn't have a 6 month wait.

Switch Drs, I wouldn't trust them.

They are just trying to suck money out of insurance. Having you run back and forth for 6 months before surgery is more money for them.

[ky Dan 32]

I live in Ky and have it. Mine was 3 months.

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[rolosmom7 740]

I have BCBSAL but live in NC. 6 month diet and some letters back and forth before I was approved

[Bonnie in La 44]

I have BCBS of IL and live in Louisiana. My first visit with my surgeon was July 1, 2016 and my surgery was Monday September 19. I wasn't 100 pounds or more overweight nor did I have a BMI of 40 or more. So, the requirements for surgery was BMI of 35 or more and one of the following ... It was medically approved because My BMI was 39 and I have sleep apnea. Requirements, psychological evaluation, PCP clearance, 30 day visit with surgeon. My surgeon's office emailed me the requirements from BCBS. Look at www.whyweight.com there's a place on there to get free insurance verification. Your surgeon may require the extras.

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[goaldigger33 39]

Thanks everyone!!! I just called their office today and now they've changed their tune and said that after I have my psych eval they will submit to my insurance. Well, okay then!

@OutsideMatchInside- I think you're spot on! Seems super sketchy and I'm sure it's just a ploy for more $$. Ugh makes me so upset because I'm going to a reputable surgeon, supposedly.

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[Mzkuntrythyck 2]

I have BCBS of IL there is no supervised diet at all

[ocgirl15 667]

I was BCBSIL but lived in MD and was told the same thing. BCBS MD did require 6 months but BCBSIL did not. I was right they were wrong. I did the 6 month program to humor them. I wasn't in a hurry. I could have fought it and you should if it is important to get the surgery quickly.

[DillThePill 18]

I posted on this topic a couple of days ago. Apologies for the duplicative post if you've already read it.

So, I have BCBS of IL but currently reside in Virginia. My surgeons office told me that insurance requires 6 month MSWL. I spoke with BCBS of IL (twice) and they assured me that there is no 6 month MSWL requirement. I then spoke to the surgeons office again and told them what insurance told me and the response was "we have to follow the BCBS of Virginia guidelines". Ummm...what?! Why?! It makes no sense to me. I don't have BCBS of VA!

Has anyone had a similar experience? I'm so annoyed with these people. Why would I have to follow VA guidelines when my insurance doesn't require it?! Sigh...

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That is such a similar experience to mine. Is your surgeon in the Inova Bariatric practice?

I'm still upset with the coordinator, Pam, because even after I convinced her that I didn't need the 6 month program, she insisted that she was required to submit it through BCBS of VA. After a couple of weeks of not getting a reply from insurance, I called up BCBSIL and they said they had no record of the claim. They had no idea what I meant about submitting it through the local BCBS and they gave me a fax number to submit it directly to BCBSIL. I called up and left a message with Pam. She never replied to my message but, lo and behold, when I checked back with BCBSIL, they received my claim on the day I gave the fax number to Pam.

This was important for more than the disappointment of having to wait longer. My insurance rolls over to a new year on Dec 1 and I had already hit my out of pocket limit for the year. Now my surgery is after my deductibles and limits reset so it's going to cost me about $1500 more out of pocket.

I considered changing to a different practice but the surgeon I chose is very well regarded and resetting the process would only delay it more.

[kblanc 53]

I posted on this topic a couple of days ago. Apologies for the duplicative post if you've already read it.

So, I have BCBS of IL but currently reside in Virginia. My surgeons office told me that insurance requires 6 month MSWL. I spoke with BCBS of IL (twice) and they assured me that there is no 6 month MSWL requirement. I then spoke to the surgeons office again and told them what insurance told me and the response was "we have to follow the BCBS of Virginia guidelines". Ummm...what?! Why?! It makes no sense to me. I don't have BCBS of VA!

Has anyone had a similar experience? I'm so annoyed with these people. Why would I have to follow VA guidelines when my insurance doesn't require it?! Sigh...

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I have bcbs for IL too and I live in Texas. I didn't have to do that just the normal apts for clearance for surgery

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[kblanc 53]

I have BCBS IL PPO. I live in Texas. Often they try to file under TX, or don't look at the fact that mine is union insurance. That said, I do NOT have any supervised diet. Just the surgeon's requirements (Psych, nutrition class, EGD). I have had trouble in the past with them not filing correctly, but most offices file IL and I have zero issues. I'm not sure about Virginia laws, but I know several people with out of state plans that don't have issue.

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I have the same as you and live in Texas and I didn't have to do what she's having to either just the regular requirements for clearance

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[Yvette804 43]

I have BCBS of ILLINOIS and live in Virginia, my doctor submitted the documents on 12/6/16. Do anyone have an idea of how long does the pre-approval process is?

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[sarahjane89 5]

I have BCBS of ILLINOIS and live in Virginia, my doctor submitted the documents on 12/6/16. Do anyone have an idea of how long does the pre-approval process is?

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I have BCBS of IL and my pre-determination took 2 weeks! I called them multiple times during the process to check on it. I'm not sure if that helped but it's worth a shot!

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[Yvette804 43]

Thanks, by the way did you have any issues come up?

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