Question:
Has anyone with BC/BS of Illionis been approved for WLS?

I have had WLS, and I'm doing great. A friend of mine is checking into surgery again. She tried once and was denied, she just thought her insurance wouldn't cover. (BC/BS of Illionis) I've been trying to find someone who might have had the same insurance and has been approved. She meets all requirements for surgery..Any help would be a big help to us!..Thank You    — T H. (posted on January 6, 2005)

January 6, 2005
I have bcbs ppo of Illinois. I had the ds almost 3 years ago. It really depends on the policy of the company and the riders on the policy. Policies all differ and companies cover differently so you can't go by just the name of the insurance company. Good luck.
   — [Deactivated Member]

January 6, 2005
I had BC/BS of IL HMO and their requirements were ridiculous. I worked for a year to meet their requirements and then they changed them. I then switched to BC/BS of IL PPO and it took about five weeks to get approved. Like the previous reply said, have your friend call BC/BS and find out if WLS is covered on that specific policy...some companies are doing exclusions now because of the costs. Best of luck to your friend!
   — dodie72

January 7, 2005
I Have BC/BS of Il. I was approved in less than a week with the proper documentation. I had to have proof of a 6 month medically supervised diet, a letter of medical necessity and have a bmi of over 35. I called BC/BS and asked the rep what the requirements were for my policy before I started the paperwork. They were great to work with. They forgot to approve the hospital stay when the surgery was approved and I didn't find this out until the day before surgery. All I had to do to take care of the mix-up was call them. They then called the hospital and had everything taken care of in a matter of minutes.
   — plucmn

January 7, 2005
They started making it harder for people to get approved around July 2003. You must have a year of a Dr supervised diet that is documented by the physician or else don't even bother. My profile says it all about I what I went through. I was never approved for surgery.
   — Kara J.

January 8, 2005
I also have BCBS Illinois PPO. You can read about my insurance nightmare with them, post-surgery, on my profile. While the amount of difficulty you may have, if any, does depend on your policy, their customer service leaves alot to be desired as far as sharing information between dep'ts and following through on what they say they will do. If you believe you've met all their requirements and are still given the run-around, do not give up. I was a real pain, calling frequently and (while I remained polite even when I didn't want to!) being firm in my belief that THEY had made a huge mistake and that my next step would be to communicate this with the State Insurance Regulatory Commission. It seemed that once I said this, things changed. There doesn't seem to be any rhyme or reason to the way insurance companies are making their decisions these days, as some people have a relatively easy time with approval, while others who clearly meet the requirements are given a very hard time. GOOD LUCK!
   — jerseyjuji

January 12, 2005
I had BC/BS Illinois HMO and they approved me with no problem 6 months of medically supervised diet and BMI of 40 or more but that was back in 12/2002
   — Cindi A.

January 12, 2005
2 years ago I only had to show that I was 100% above the ideal weight. At 4'11' and 260 that was not a problem. When I called before my parerwork was submitted by the Dr. office I asked first if it was covered by my specific policy and was told that the only requirement was the 100% overweight. The person I talked to was fabulous, and shared with me that a guy in her office had WLS and his results etc and wished me good luck and told me she was sure I would be very happy I did it. this was summer 2002. things may have changed since then.
   — **willow**

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