Question:
BC/BS of Illinois - Cobra

Can anyone tell me if they have dealt with BCBS of IL who has COBRA insurance? I am on my 4th month of the 6 month supervised diet so I am beginning to get a little anxious. I have called the ins. company and they say that yes, it is covered, I just want to know if anyone else has been told yes and then when the approval went through you found out the answer was no. Please give me some peace of mind, either way!!    — hannahsm0mmy (posted on June 25, 2007)

June 25, 2007
I have BCBS of IL, but not Cobra. Call customer service & get a copy of the portion of the policy that has to do with WLS. I was denied x 2 & had to go to appeals, but did get approved after 19 months. They are tough, but it has been well worth it. I am 4 months out of RNY & down 96 lbs.!!! Send me an email if you want further info. God Bless!! MK
   — asinmouse

June 26, 2007
Hi Amy, thanks for writing. I have BCBS of Ill for myself as well. Cobra means that you or your spouse left their job, and without insurance coverage, you are covered by Cobra, but are paying huge premiums to keep yourself covered. Cobra gives you the exact coverage you had with BCBS, but you pay through the nose with it. I am writing this because my answer is based on this fact. If your surgery is a covered item in your policy that you had prior to taking it through the Cobra plan, and you have completed all the requirements and are still not able to lose much weight, they should approve the surgery. I have a PPO with them, and they have been superior in coverage for me. They covered fully my tummy tuck and I had gyn surgery and a twisted bowel this last year and it was fully covered. Be careful about your percentage. My plan was a 90% plan, which meant I was liable for the 10%, so you will need to pay something is you do not have a supplement. I do, and so it cost me nothing (Praise God), but if you don't you will endure a co pay of up to 10% of the allowed charges, which can be upto $2500. You won't have peace of mind until you get that approval, but once you are done with the "program", then call them every 3 days or so and ask how the approval process is going. Staying in touch with them only helps you and helps them know you are not going away anytime soon. If they deny you, appeal, and get an attorney if you need to, but it does sound like they are gonna approve, in my opinion. Take care. Patricia P.
   — Patricia P

June 26, 2007
HI AMY....I HAD AETNA INS. AND HAD JUST GOT APPROVED ATER THE FIRST APPEAL AND THEN MY COMPANY SOLD AND MY INS.WAS TURNED OVER TO BCBS...SO I WAS GIVEN THE OPTION FOR COBRA THRU AETNA AND THEY SAID EVERYTHING REMAINS THE SAME. SO ACTUALLY IF I HAD WANTED I COULD HAVE GONE WITH 2 INS. PRIMARY AND SECONDARY. HOPE I MAKE SENSE GOOD LUCK IN YOUR JOURNEY! PAM
   — Pam S.

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