BCBS-IL ????'s

[bouwks 0]

I was wondering if anybody had experience with the 6 month Dr. supervised diet required prior to approval of the lap band. The wording in my plan states that you must have been on a Dr. supervised weight loss plan for at least 6 months in the last 2 years. So.....starting in April of 2007 I started seeing a doctor for about 5 months. I then stopped for 3 months, started again for another 4 months and then saw him off/on over the last year. I saw him a total of 16 times in a 20 month period but never for 6 months straight?!?!?! I've read a lot of the posts and looks like it just kind of depends on the provider but I submitted my documents three days ago and am starting to get a little ansty.....

Thanks for all the help.

[*slim* 2]

I was approved with BCBS-Il with a 6 months plan that had been done in 2006, but my plan didn't really specify whether it had to be 6 months straight. I was lucky enough to have seen my doctor at least once in each of those 6 months so I didn't have to find out. You might want to call and ask about it. I am wishing you the best, and that you get a quick approval.

[BigMomma1981 0]

My insurance was BCBS IL also and I was told by the nurse through the insurance company that the 6 month PCP visits had to be in a row. My surgery was approved within a few days. GOOD LUCK

[bouwks 0]

Thanks for the info.....I should hear back next week so I'll let you'all know what I find out.

[stacy0830 0]

I'm just starting this process and I posted something in the pre surgical thread. I guess it should have been here. I also have BCBS IL and I wondered if I would have to be enrolled in a specific plan for 6 months or if I had 6 doctors appointments in 6 months concerning my weight and she advised me on options during the visit would qualify.

[mandilou 1]

My surgeon's office is really great about finding out exactly what the insurance company requires in order to get approval. I have BCBS-IL and had to do six months supervised visits in a row. I've got two more to go. From what I'm hearing, in the past year BCBS-IL has gotten a little more forgiving in terms of approval, assuming you do follow all of their guidelines. I would find a surgeon or hospital well-versed on BCBS-IL insurance and they'll be sure you cover all of your bases.

[mandilou 1]

stacy-

From what my surgeon said, sometimes a PCP doesn't put all of the necessary information in your file that would help with submission. I tried to use my PCP visits (which were specifically for obesity) to count towards my six visits, and there wasn't enough information for them to use towards approval. If you're not going to use your surgeon's office for the six month appointments, make SURE your PCP has EXACTLY what the insurance company needs, so you are 100% sure you've submitted everything you can to ensure approval.

[bouwks 0]

Got it.........Just got a call from the Surgeon's office and BCBS approved the surgery!!!!! Looks like they can't get me in till the 1st week of March so I have a month to wait but at least it's gonna get done. Thanks for all the support and I'll keep everyone updated on the progress. YeeHaw!!!!

[shelli310 0]

Congrats! I have BCBS IL as well; Just went for my first consult Dec 30th. Have had my preliminary visits (2 w/ surgeon, psych eval and nutritionist); now waiting for letters to be submitted to see if they will approve! Also crossing my fingers that they accept the lo-cal plan I went on 8 months ago as my 6 month lo-cal diet.......we will see!

[stacy0830 0]

Thanks so much Mandilou for your answers. My visits with my PCP weren't always specifically for my obesity, but my doctor always documented weight and blood pressure and we discussed different options, and she wanted to make sure that I was getting excercise, etc. I hope it works!!!

[*slim* 2]

Thanks so much Mandilou for your answers. My visits with my PCP weren't always specifically for my obesity, but my doctor always documented weight and blood pressure and we discussed different options, and she wanted to make sure that I was getting excercise, etc. I hope it works!!!

The information that you mentioned is what was used to approve my surgery through BCBS-IL. Good luck!

[JUSTTIRED 0]

Oh this makes me so excited... I've finished the 6months and I have my psych eval on Friday yes thats tommorow and my Nutrition appt on the 26th..then submittion..i'm praying so hard!!

Just Tired

[ravin2faith 0]

I have BCBSIL as well. My claim was submitted yesterday with all the requirements including my 6 month diet! I am waiting on the decision from my insurance carrier. :biggrin:

[mandilou 1]

This thread is great news to me... I kept hearing HORRIBLE things about BCBS-IL, and it's thrilling to know that some of you have been approved in days. I'm still nervous, but with all my ducks in a row, I have a lot more confidence than I did a few months ago about approval. :smile:

I have two more supervised visits to go... one of which will be with my surgeon. But I can't schedule that last appt. until ALL my paperwork is in, which includes my psych eval (which I'm finishing up Monday) and some prior paperwork from another psychiatrist (who is killing me, because she's been out of the office for nearly two months on "personal leave", and her assistant won't send my files without permission from the doc).

[lose2regainme 0]

Best of luck to you all with BCBS-IL. I am having a nightmare with them right now. I qualify in every way they require, but they declined me because my dr's notes on the 6 month thing weren't "specific" enough. My Lap Band surgeon has referred my case to an obesity law and advocacy attorney. Now I am waiting on that and really starting to get deeply depressed. My doctor has left her practice so if they deny again, I START OVER!!!!!!!:smile: