Anyone with BC/BS Illinois ever approved??

[Ellisa 6]

Oops, this is a thread I didn't get back to. Banded on 12/18/07. It all went very smoothly. My doc allows pureed the day after surgery for 2 weeks before soft foods for two weeks. I'm not hungry at all, but I'm sure that will change once the swelling goes down and the gas is absorbed. I'll keep checking to see how you ladies fare with insurance.

[Tamihott 0]

I am soo happy that you are doing well! Have a great holiday season and happy losing! I had my 2nd app with pcp supervised diet on friday and I have lost 10lbs. I had my psych eval on sat and are slowly getting all my medical records in order. I meet again with the surgeon on the 7th of Jan. I will keep you inforned! Tamara

[Sloankw 0]

I had BCBS IL too and it took me from Oct 06 until Sept 07 to get everything done and get approved. I had the help of two wonderful lawyers though after I got denied the first time, and after one appeal letter from them I got approved. It didn't even cost anything. I was banded on 11-06-07. BCBSIL is a real pain though. I know how it feels to get those letters telling you that your missing something or that you don't have enough documentation proving that you were obese for 5 years. It's hard to get discouraged, but just keep your head up.

[Athey 0]

My MIL has BCBS of IL and she's been trying to get approval for a band for almost a year with no luck. They just keep sending her in circles. Totally giving her the run-around.

She's got diabetes and loads of other health problems that would all be solved by getting banded, and they still won't do it.

My DH is getting banded in a few days and when he decided to go for it and went to the doc, we got approval from our insurance (BCBS of CA) really quickly.

It's amazing how different insurance companies can be - even blue cross from diff states.

[Northern Mist 2]

I sure hope my story turns out positive. My pre-op stuff was turned in last week. Been working on it since May '07. Crossing my fingers!

[Ceradad 10]

I just found this site not long ago and just now found this thread. I have BCBS of IL. As soon as the clinic found out I had them they got that "look" on their faces. They knew all about BCBS of IL. They knew I was going to have to go through 6 mos with a dietician and a couple of other obstacles to overcome. The 6 mos seemed to be the worst and I could deal with that, at the time. I just looked at it as a headstart on changing habits for afterwards. As I was 6'3" and almost 380, and had been fighting my weight for over 15 yrs, I figured it was a simple deal.

Little did I know. I started with the dietician in January of 07. I was told I had to see the dietician pretty much on the dot every 30 days or they would deny me for not following the "monthly" appts. This was a little difficult as the dietician was due in May of 07. Regardless, I made it. In May, I called BCBS to verify that the January through June was going to be good or if January didn't count as it was the initial consultation with the dietician. Couldn't get a straight answer to save my life.

They almost came out and said I was good. So, after the June appt, my clinic sent in all the paperwork to BCBS. After a week, I called up BCBS to check on the status of my request. I was told I had been denied for failing to follow their guidelines. Cust. Rep would tell me exactly why. But he did tell me they thought people got the Band and then went right back to their old eating habits.

I called the nurse I was assigned to at the clinic and informed her of what was said via voicemail. I was called back by the lady that handles their insurance paperwork and was told she would call BCBS.

She called me back a couple of hours later and she was PISSED!!!!!!!! She could not believe what BCBS told her. Basically, they told her that fat people, or "those people", got nothing out of the surgery. They said I was denied for failing to learn anything from the dietician. Their reasoning was that my weight fluctuated each month by a pound or two and I would revert back to old eating habits afterwards. They also didn't believe it was a preventitive surgery.

Little back story on the clinic I went through. It was Park Nicollet Clinic in St. Louis Park. They have 3 surgical teams that do nothing but gastric bypass. To be a nurse or a staff member of this clinic, you have to have had gastric bypass (other than the surgeons). They do this so they know what the patients are going through each step of the way.

Anyway, the lady from the clinic went OFF on the cust rep from BCBS. She told her off good. Flamed him for the companies attitude. Then, told him to put my request in appeal. When he asked if that was what I wanted to do, she told him to just do it and she would ask me later. I loved it when she told me this. I knew I had decided to go with the right place.

Any way, long story longer, I had the appeal approved in less than 3 days. After figuring out my schedule and the surgeons availibility, I had my surgery on August 28, 2007. I'm down almost 90 lbs and haven't looked back. No fills as of yet and I love my clinic.

If you live in MN, I highly recommend PNC. But, more importantly, if you are denied, TELL them you want your request put into appeal. They don't tell you about that option and you don't need a lawyer. It is a neutral 3rd party that looks over your request. If they approve you, BCBS HAS to abide by it. If they deny, then look further. Just don't give up. That is what BCBS wants you to do. PNC told me they have around 10-11 patients a year w/BCBS of IL. Of those, on avg, 8 get denied. When I asked if most are approved on appeal, I was told most simply give up. I was not going to do that.

Thanks for reading my novella.:frown:

[KayleighsMommy 16]

I also have BC/BS of IL. Reading all your stories made my anxiety level go up a few notches. I called my surgeons office to make a initial appt. they took my insurance info, called back and told me I had "excellent benefits" ... bariatric coverage, no copay, no deductible, no prerequisites, the insurance girl at the office told me she wished she had such good coverage.

Now comes the rub... I am still waiting on a preauthorization...the doctors office said they faxed in on Wednesday...they claimed they never got it...she has been trying all day to refax it...been unable to get through. Also..the doctor is sure I have sleep apnea (by my symptoms) he will not do the surgery without a sleep study (btw..I also have a incarcerated hernia he will fix at the same time) The problem is BC/BS is giving a hassle about the sleep study...they want 12 months of documentation of sleep issues...now correct me if I'm wrong...but if you have been compaining to your doctor about waking up gasping at night for a year and your doctor has not already sent you for a sleep study, isn't he pretty much a moron?????

I called the ins co today to find out what they want...they had it documented that I had a BMI over 38 (way over), extreme snoring, daytime sleepiness, etc.

The service rep game me the runaround...told me it could take anywhere from 14 days to 2 months for a reevaluation, once my doctor sent all the required info....which of course, they did, since she told me what was listed. She kind of suggested I keep my scheduled appt and send it in for reevaluation. I asked her if they found I had sleep apnea would that be considered medically necessary for the test. She actually had the gall to tell me "it depends on what your benefits are"...mind you this is after going round and round for 30 minutes about what "medical neccessity" is. I told her "You're the one with my benefits in front of you...tell me what they cover". The first thing they she said was medical neccessity can be determined by a sleep study WTF?????? :tt1: At this point I was almost in tears, practically yelling at her...then my cable went out and dropped the call. I am sooooo livid at his insurance co.

What is the chance of them paying for Lap Band if they won't even pay for a simple sleep study??????????????????? <rhetorical question...just my frustration showing>

Sorry for the novel...just had to vent.

[Northern Mist 2]

It sucks, I know. I'm still trying to get approved - My doctor has made several phone calls and has wrote a couple of letters.

I get frustrated and stressed out every time I call them or think about it. And yes, it's extremely aggravating when the insurance rep is playing dumb!!! Exactly who do we call to get information on our coverage if it isn't them??

My husband is helping by staying positive when I'm ready to quit - thank goodness for his support.

Good luck and don't feel bad for venting - the people here know what it's like. Anyways..... venting always makes me feel better : )

[GinaJ 2]

Well, I am in the same boat as you guys. When I first looked into my coverage for lap band surgery with BCBS of IL I was very excited to find out that I met all requirements, and would have to pay a total of $35.00. My paperwork was submitted in January and I was denied in February. When I called the service rep really could not explain why I was denied. In my denial letter it just lists the policy and I meet all criteria. I was shocked!!! It's as if no one even looked at what was submitted. My doctor's office was shocked and have since turned in my paperwork to Obesity Law. They have not yet accepted my case, but I really hope I can get the denial overturned relatively soon. I can't believe all the problems people have with this insurance company.

[KayleighsMommy 16]

It sucks, I know. I'm still trying to get approved - My doctor has made several phone calls and has wrote a couple of letters.

I get frustrated and stressed out every time I call them or think about it. And yes, it's extremely aggravating when the insurance rep is playing dumb!!! Exactly who do we call to get information on our coverage if it isn't them??

My husband is helping by staying positive when I'm ready to quit - thank goodness for his support.

Good luck and don't feel bad for venting - the people here know what it's like. Anyways..... venting always makes me feel better : )

Oh, man..that sucks. I am so sorry. I guess I should not have been expecting it to be easy. I tried to have gastric bypass done abour 12 years ago...BC/BS of MI denied me then, too. At the time I was soooo miserable about it...if anyone even asked me how my fight was going I would get hysterical and start crying. I finally just gave up (after a face to face meeting at BC/BS in downtown Detroit)

This time I will not give up so easy. But geez...a simple sleep study??? Is that really too much to ask for??

[KayleighsMommy 16]

Well, I am in the same boat as you guys. When I first looked into my coverage for lap band surgery with BCBS of IL I was very excited to find out that I met all requirements, and would have to pay a total of $35.00. My paperwork was submitted in January and I was denied in February. When I called the service rep really could not explain why I was denied. In my denial letter it just lists the policy and I meet all criteria. I was shocked!!! It's as if no one even looked at what was submitted. My doctor's office was shocked and have since turned in my paperwork to Obesity Law. They have not yet accepted my case, but I really hope I can get the denial overturned relatively soon. I can't believe all the problems people have with this insurance company.

I can't believe how their customer service gives absolutley NO service!!! Unbelievable.

[Ceradad 10]

I can't believe how their customer service gives absolutley NO service!!! Unbelievable.

Yeah, I ran into the same problem when I initially called to ask about coverage. The rep said something along the lines of "as far as I can tell, you should be covered". WTF? As someone said previously, they are looking at my policy in front of them.

When I called to check on the status of my request initially, I was told I was denied. But, they couldn't tell me the reason as far as they could tell. BC/BS of IL sucks big time.:biggrin:

[GinaJ 2]

How can they not know why we don't meet criteria? When I worked for Tricare, doing the approvals for gastric bypass, we had to call the doctor's office right then, and explain why they did not meet; before the denial letter went out. I just can't understand how they say they don't know. They are unbelievable.

[KayleighsMommy 16]

Well, I am in the same boat as you guys. When I first looked into my coverage for lap band surgery with BCBS of IL I was very excited to find out that I met all requirements, and would have to pay a total of $35.00. My paperwork was submitted in January and I was denied in February. When I called the service rep really could not explain why I was denied. In my denial letter it just lists the policy and I meet all criteria. I was shocked!!! It's as if no one even looked at what was submitted. My doctor's office was shocked and have since turned in my paperwork to Obesity Law. They have not yet accepted my case, but I really hope I can get the denial overturned relatively soon. I can't believe all the problems people have with this insurance company.

Gina,

Just wondering who the empoyer is that supplies the insurance?? Mine is through my husband who works for AT&T (just wondering if it makes a difference wether they pay on a company by company basis)

julie

[GinaJ 2]

I am insured through my employer, Centene Corp.