Blue Cross Blue Shield of Illinois

[Exarmy30 0]

Hey every one. Im new on here and I just switched companies, and found out my new Company Veolia Enviornmental Serv. uses BCBS-IL. I made a phone call and they said that currently my company has no exclusions on it and BCBS-IL will cover gastric banding but not bypass and with a few conditions. I was wondering if there is anyone else out there that has had bariatric surgery of any kind with BCBS-IL and what their experience was pushing the paper work through the insurance co? Thx James

[tiffanye 0]

I don't understand these insurance companies. But I have BCBS IL Federal. I had my surgery in Indy so it goes through Anthem BCBS. But they say that I still have the same coverage.

[Bobbie155 0]

I have BCBS of PA and I had to see my PCP for 6 straight months I also had to have a psyc eval and see the dietician just one time. After I had all of that they sent it to the insurance company and I was approved in less than 48 hours. There is no pushing the paper work through you have to get what they require or they will just say no to the surgery. Good Luck and hang in there.

Edited March 9, 2009 by Bobbie155

[KayleighsMommy 16]

Hey every one. Im new on here and I just switched companies, and found out my new Company Veolia Enviornmental Serv. uses BCBS-IL. I made a phone call and they said that currently my company has no exclusions on it and BCBS-IL will cover gastric banding but not bypass and with a few conditions. I was wondering if there is anyone else out there that has had bariatric surgery of any kind with BCBS-IL and what their experience was pushing the paper work through the insurance co? Thx James

James,

I really hate to be the bearer of bad tidings, but BC/BC of IL os HORRIBLE. There are a couple of threads about them out there. I am hoping it may be easier for you... but they made my life not so pleasant (to put it mildly) This doesn't mean you shouldnt fight, of course (and I suspect it will be a fight.) All I can say is please don't take the word of the first person you talk to.... my experience of them is no one there knows what they are doing, and you will get 5 different answers from 4 different people, Good luck on your fight, I am really hoping this works for you!!! Julie

[Exarmy30 0]

Well I appc. all yalls responses and would appc. anymore comments on BCBS-IL PPO.:w00t:

[Exarmy30 0]

They definetly can be confusing Tiffanye.

[crikey2 0]

Well I appc. all yalls responses and would appc. anymore comments on BCBS-IL PPO.

I just saw my lap band surgeon yesterday and have bcbs il ppo. I have been under my gen dr's care for the past 18 mos for COPD, severl sleep apnea, RA and gerd. I have decided to do lap band. I have scheduled the req tests and will be done by 4/7. I have also had most of the req testing prior as they were test that dr just orderd. However, the dr told me to contact bcbs and see what their requirement is, usually 6 mos supervised diet. I contacted bcbs and they need my surgery date before anything else...i can't get a surgery date until I know what their requirement is...big circle jerk... I am hoping to speak to one of the nurses tomorrow who deals with the insurance end..I am hoping I do not have to wait the 6 mos as I have been closely medically supervised for other reasons. We'll see. Tomorrow the Quest continues

[JUSTTIRED 0]

Dear Ex Army

I too have BC/BS of IL...it has been a nightmare. I did the 6 month diet/ saw my pcp faithfully he filled out the form, I forwarded to my Surgeons office, for the file there. Had my psych eval and once was done with nutrition appt was submitted. Wel it was decline in 1 day. Because my pcp didn't include enough detail in the 6 month appts and they didn't like the format of my 5 yr weight history. So my surgeons office works with Obesity Law and they now are fighting my appeal. When they reviewed my paper work they found all kinds of red flags on my psych eval...lots of detail way too much and too many howevers and in the event of's. (it was like she was covering her butt so that in the event I went wacko after surgery I could say she said I was fine to have surgery)

So my advise is be very careful before you submit for the 1st time. Make sure ever i is dotted and every t is crossed and that all paperwork is in order before you get denied...because then you will be in appeall for a long time. Work with your surgeons office but follow behind them and make sure all is in order. Best of luck, hope your story doesn't turn out like mine did. My employer will be changing Insurance carriers May 1, 2009 so if my appeal doesnt' get done I'm screwed.

Just Tired

[iwalktheline 1]

i was just banded in feb and have bcbs il and live in chicago.

i had absolutely NO problem and my payment was $100. for about 28,000. in charges. i went to my pcp in july, went everymonth for a weigh in till dec. saw a psych, nutritionist, upper gi, excercise phys and pulmonologist and surgeon. so i would say i had about 13 visits total. that was a PIA, but i was determined. i also only had a bmi of 36. i think the reason i had an easy time is because im HMO. i heard PPO is more difficult.

[WonderWmn 0]

I also have BCBS of Illinois and I'm just starting out with my pre-qualifications... the 6 month medically supervised plan and the required consults. I called my insurance to verify what the surgery center quoted me and they were wrong. They told me my deductible was $500 but it turns out that it's actually ZERO!! Luckily my employer chose a plan that covers 100% of the surgery so I only have to pay for the nutritionist... I find it ironic that they require a nutrition consult, yet they don't cover it... anyway, I'm just glad that everything else will be covered.

I have the PPO and I'm making sure that everything required is documented and once I complete my last visit on August 13th, then we're submitting those puppies. I'm trying to have my surgery on Labor Day weekend since we get a 4 day paid weekend at work, so that will save me some vacation days... I'll update once I get to that point... good luck everyone!

[JUSTTIRED 0]

Just wanted to update...after my Drs office turned my file over to Obesity Law and Advocacy and they filed my appeal I was finally Approved. Yippee <insert happy dance here> I have surgery April 16, 2009. Good luck on your battle..but keep fighting.

Just Tired

[Kennedy Conway 0]

Just wanted to update...after my Drs office turned my file over to Obesity Law and Advocacy and they filed my appeal I was finally Approved. Yippee <insert happy dance here> I have surgery April 16, 2009. Good luck on your battle..but keep fighting.

Just Tired

I pray you have the easiest surgery & fastest healing possible. I wish you the very best. I know you're 1 day post op but hang in there.

[twhy48 7]

i was just banded in feb and have bcbs il and live in chicago.

i had absolutely NO problem and my payment was $100. for about 28,000. in charges. i went to my pcp in july, went everymonth for a weigh in till dec. saw a psych, nutritionist, upper gi, excercise phys and pulmonologist and surgeon. so i would say i had about 13 visits total. that was a PIA, but i was determined. i also only had a bmi of 36. i think the reason i had an easy time is because im HMO. i heard PPO is more difficult.

I live in Chicago and I am looking to begin this process. I just switched to HMO from PPO in January so I have yet to visit my new doctor. I would love to know the name of your doctor as it seems they were supportive (I have a BMI of 43 and I keep getting told I need to be on a 1500 calorie diet...thanks genius). I have had little support in my process up to this point. Any help would be greatly appreciated. Thanks!