Does anyone have BCBS of Illinois?

[jessress87 0]

I am insured through my work by Blue Cross Blue Shield of Illinois PPO and I am just in the beginning stages of the whole process (as some may have read in my introduction post). I am 22 years old and have a BMI of 48.5. I went to my PCP last Friday and he referred me to the local WLS surgeons. They faxed my info to the Bariatric center on Monday and the Bariatric center called me and scheduled a Lap-Band seminar which is next Tuesday (10/13).

I'm pretty excited about the seminar, I just want to get the whole thing under way! I read that in July BCBSIL dropped the 5 year history and changed the 6 months supervised diet to 3 months, can anyone verify this? What else did you need to do? I've requested a list of the requirements from BCBS but I'm very anxious (and wondering why if they said they were sending it Monday I don't have it yet on Friday) How has your experience with BCBSIL been? I want to make the process as smooth as possible so I was hoping I could get some advice. Any help would be great!!

[GraciesMom 0]

Yeap, BCBS of IL has dropped it to a three months, just did my last weigh in yesterday. I hopefully will know within 2 weeks that I have my final approval and get a surgery date.

Congrats on getting the ball started, that is the hardest part (besides all the waiting). Just keep them foots a moving in the right direction and it will be done and over before ya know it!.

Best of Luck!

Cheryl:thumbup:

[pickles123 0]

I have BCBS of IL and their was no preop diet or 5 year history. The only thing they required were the Psych exam and the Nutritional consult. The remainder were requirements from the surgeon. My PCP did write a letter so that may have been required, I don't know.

[GraciesMom 0]

Hi Pickles, I think the preop diet ( just before surgery)is what the surgeon requires , not the insurance.

But they do require a medically supervised diet (the three months supervised visits), a phyc eval, a cardio release, and the rest is up to your surgeon. I just heard of a surgeon that requires a pap smear before hand too.

Just do what your sureon says that they require, they are the experts at getting approval with the insurance companys...and if you have a approved Bariatric Surgeon of Excellence as listed on the BCBS of Il PPO web site, you are good to go.

Cheryl

[jessress87 0]

Yeap, BCBS of IL has dropped it to a three months, just did my last weigh in yesterday. I hopefully will know within 2 weeks that I have my final approval and get a surgery date.

Congrats on getting the ball started, that is the hardest part (besides all the waiting). Just keep them foots a moving in the right direction and it will be done and over before ya know it!.

Best of Luck!

Cheryl:thumbup:

Do you mind if I ask you if your pre-op care was covered and if you know if the fills and post-op care are covered?

[tiffanye 0]

I have BCBS of IL my husband works for the Post Office so I can't remember if it was different or not (its amazing how much you forget after you have had your surgery) But anyway here is just some FYI that you will have to check into...If I was doing outpatient surgery I was going to have to pay for all the medical supplies during surgery but if it was outpatient I would just pay my $100 copay. I had mine done in Indy since that was so far away the doc wanted me to stay the night so tada inpatient. And all of my fills are $100 just a heads up (ouch I didn't know that when I had the surgery and it stops me from getting fills sometimes.)

I didn't have to do a 5 year or 6 month diet. I met the requirements and was approved a week later.

[jessress87 0]

I have BCBS of IL my husband works for the Post Office so I can't remember if it was different or not (its amazing how much you forget after you have had your surgery) But anyway here is just some FYI that you will have to check into...If I was doing outpatient surgery I was going to have to pay for all the medical supplies during surgery but if it was outpatient I would just pay my $100 copay. I had mine done in Indy since that was so far away the doc wanted me to stay the night so tada inpatient. And all of my fills are $100 just a heads up (ouch I didn't know that when I had the surgery and it stops me from getting fills sometimes.)

I didn't have to do a 5 year or 6 month diet. I met the requirements and was approved a week later.

Yowie! $100 is a pretty penny, but I reckon it's worth it :thumbup:. How often are fills typically? I've not stumbled on that bit of info yet.

[GraciesMom 0]

Do you mind if I ask you if your pre-op care was covered and if you know if the fills and post-op care are covered?

It did pay all the other appointments that I had to make, however I still had to pay the % it doesn't cover. i.e. $5.00 per surgeon visit, $20.00 here, $10 there, but that was how my husbands insurance has it written, I believe they pay up to a certain percent and then we cover the rest. PLUS my sureon has a add on of $300.00 that he charges that insurance doesn't cover. It does however cover the cost of getting a nutritionist ( he has one come in and give a class), he also supplys us with vitamines, and some other stuff, so it is a value.

Nuttin my friend is free, it just ain't gonna happen, but having BCBS of Il is pretty great insurance and is truely the only way I could do this.

Good questions, keep asking because these are great people here, but keep the actual medical stuff to ask to your surgeon.

BTW, where are you going? I am going to Dr Lahmann in Joliet.

[jessress87 0]

It did pay all the other appointments that I had to make, however I still had to pay the % it doesn't cover. i.e. $5.00 per surgeon visit, $20.00 here, $10 there, but that was how my husbands insurance has it written, I believe they pay up to a certain percent and then we cover the rest. PLUS my sureon has a add on of $300.00 that he charges that insurance doesn't cover. It does however cover the cost of getting a nutritionist ( he has one come in and give a class), he also supplys us with vitamines, and some other stuff, so it is a value.

Nuttin my friend is free, it just ain't gonna happen, but having BCBS of Il is pretty great insurance and is truely the only way I could do this.

Good questions, keep asking because these are great people here, but keep the actual medical stuff to ask to your surgeon.

BTW, where are you going? I am going to Dr Lahmann in Joliet.

Thanks for all the info! I actually live in Ohio, I'm not sure which yet but it's going to be either Dr. Clarey or Dr. Bruce in Dayton.

[1SkinnyChick 0]

I am insured through my work by Blue Cross Blue Shield of Illinois PPO and I am just in the beginning stages of the whole process (as some may have read in my introduction post). I am 22 years old and have a BMI of 48.5. I went to my PCP last Friday and he referred me to the local WLS surgeons. They faxed my info to the Bariatric center on Monday and the Bariatric center called me and scheduled a Lap-Band® seminar which is next Tuesday (10/13).

I'm pretty excited about the seminar, I just want to get the whole thing under way! I read that in July BCBSIL dropped the 5 year history and changed the 6 months supervised diet to 3 months, can anyone verify this? What else did you need to do? I've requested a list of the requirements from BCBS but I'm very anxious (and wondering why if they said they were sending it Monday I don't have it yet on Friday) How has your experience with BCBSIL been? I want to make the process as smooth as possible so I was hoping I could get some advice. Any help would be great!!

The 3month supervised diet is TRUE!!! Thank goodness. I attempted to go through the banding process 2 years ago with bcbs-il, hmo, near impossible. I then switched to PPO and was told to supply very extensive medical/weight history, which I could not do. I got very discouraged and gave up any hopes of being banded until I re-visited the board on a whim and heard about the 3 month supervised diet.

I went to Day One Health, and on my first appt 8/3/09 met with the dietician who then scheduled me for two more appt 9/3 and 10/3 with her and the rest is history.

Approved 2 1/2 weeks later, pre-op testing 11/23, banding 12/7.

Yay!!!:smile2:

[PWoo10 7]

I have BCBS IL and I was told they are the hardest to approve the surgery. I was denied and next year I am going to BCBS IN so I should have a better chance. Good luck.

[vonhelzing 3]

skinnybitch,

I also went to day one. Do you have dr meyers? he is great. i'm over a year out and never had a problem. I also have bcbs of il and never paid a thing except my co pay. Day one didn't charge all these extra fees. I do think that the fills there are $250 out of pocket but the insurance covers them.

[1SkinnyChick 0]

skinnybitch,

I also went to day one. Do you have dr meyers? he is great. i'm over a year out and never had a problem. I also have bcbs of il and never paid a thing except my co pay. Day one didn't charge all these extra fees. I do think that the fills there are $250 out of pocket but the insurance covers them.

I have Dr. Elli. I met Dr. Meyers, though, and my friend was banded by him. He is great. Very patient. Skilled.

I haven't had to pay a thing, either, and I know BCBS-IL was horrible about approving before, but the process is so easy now. I highly encourage anyone who was scared off before to try again now. Day One's staff should also be commended for their hard work and thoroughness. That goes a long way in approval as well.

I have had several visits, and as you said I only had to pay co-pay.

20.00 for Surgeon Consult

20.00 for Psysch Eval

and I'm sure another 20.00 for pre-op testing.

I even saw the dietician there at no cost to me. They bill the insurance. If BCBS-IL pays, great, if not, Day One will not charge me.

I think they have a great program. 3 visits and BOOM. approved.

[mznita 0]

Dr. Myers performed my banding on 11/13/09 at Rush. I do have BCBS-IL PPO. I had to do 6 months with the nutritionist, blood work, and some more test but I think that was for Dr. Myers. So far I have had to pay $10 here, $20 there, no huge amount as of yet.

Start weight 276

Surgery 11/13/09

Current 252

Edited December 3, 2009 by mznita

[Northern Mist 2]

I finally got approved after the fourth time!

The first time I was denied because (after all the tests, eval's, etc...) the surgeons office didn't include everything or BCBS "lost" some of the fax.

The second and third time when I turned in the 6 month supervised diet and exercise logs BCBS told me the logs didn't contain enough notes from the doctor.

The fourth submission contained extensive notes and my doc's signature on every single days diet and exercise information.

I steadily lowered my points and upped my minutes of exercise over the three month period and lost 16 pounds. The progression of the diet and the daily notes is what BCBS said finally made them approve the surgery request.

Thank god my doctor was just as stubburn as I am - she spent 30 + minutes just going over my diet and exercise logs at every appointment. Thats dedication to your patient!

My advice - be very, very detailed!!!

I believe co-pays, percentages and out of pocket costs, etc.... vary with individual company contracts.

Good luck! It will happen.