Anyone Have BC/BS of IL?

If so what have your experiences been, if at all possible I would like ot be approved hte first time around. What has your experience been with this insurance carrier.

I have BCBS of IL PPO. There is a difference between the PPO and the HMO. The first thing to do is contact them and ask for the "medical policy" concerning bariatric surgery on your particular policy. Ask them to fax or mail that actual guidelines to you, or to give you the link for the page where you can find them. You then need to make sure that you have documentation showing that you meet each criteria. Mine needed: 1. BMI of 40 or greater, OR BMI of 35 or greater if the patient has 2 or more comorbidites that have not responded to maximum medical treatment. 2. Documented 5 year history of MO. 3. Documented 6 continuous months of compliance with medically supervised non-surgical methods of weight reduction. 4. Evaluation by an independent phychologist/psychiatrist. 5. Documentation of willingness to comply. 6. Growth has been completed. The only thing that I was missing on my first attempt was the 6 month diet. (Actually, when I first attempted, it was 12 months....) I appealed, explaining that I had been dieting for years and years, but they would not budge. I needed documentation from the doctor's office that I came in once a month, every month for 6 (12) months. My doctor precribed Phentrmine for this and I also made a form up every month stating my goals and what I was eating, and exercising to be included with her notes. At about 8-9 months into my 12 month diet, I learned that they had changed the criteria to 6 months. I called up the lady on my denial papers, and she had me send it the doctor's notes along with my monthy formin to HER (not re-submitted), and I was approved within a week. I had my surgery 2 weeks later. I have heard that if you have everything documented that they ask for, you CAN get approved on the first try. BUT.......I have also heard that they always deny the first try hoping you will give up. DO NOT GIVE UP!!!!! Your health is more improtant than that. Sorry this is so long, but I hope I have been helpful. Good luck to you in your journey! Dawn

Dawn, I too have PPO, and I have been getting my records together now, and plan on working on it over the weekend. I have documentation going back to 1998 where my weight was high and continued to grow. My concern now is that I was monitored by my PCP when my husband was in the military, and now he is out. I meet with my new PCP who is under BCBS Monday. I plan on explaining to him everything showing him my journal documentation, my order for phentermine that I took last summer, weigh****chers goals and notes, weight related history, and hopefully he can sign off on my request and validate my charts and I can get this show on the road. My goal is to get approved the first time around......ever heard of that happening?

What does # 5 and 6 mean? 5. Documentation of willingness to comply. 6. Growth has been completed.

Hi again Tanya: I will answer both questions at once. I have heard of a VERY FEW who get approved on the first try. They usually always deny on the first try, but sometimes, it is just something technical that you have to point out to them that you sent in with the pre-approval request. The 6 month supervised diet they are VERY STRICT about. You must have copies of your doctor's notes showing the you have seen him once a month, every month (you can't miss a single month---then the clock starts over.....). It is best to make the appointments no less than 25 days and no more than 29 days apart. This is where I had my problem. I had seen the same doctor for over 5 years, and have been "supervised" in my weight loss attempts all of that time. Even when my doctor wrote them a letter explaing this, and that another year of trying would not yield any better results, and may even be harmful, they did not care. You MUST have notes for every month in a row for 6 months. They will not back down on this. I don't think it will matter what doctor you saw, as long as you saw someone once a month for 6 months. On the bright side, it sounds like you are keeping good records and will make them happy with documentation. #5: Willingness to comply-----means that your doctor or surgeon in their letter of medical necessity should mention how they know that you are willing and able to comply with the HUGE life change and change in eating and exercise habits that the surgery will require. #6: Growth has been completed----just means that you are an adult and have finished growing. If I can help in any other way, I will try! Dawn

I had BCBC of IL for years. In January, I switched to United Healthcare and was approved on the first try March 28th.

Had you made previous attempts to obtain WLS and BCBS denied you?

No. At the time BCBS was requiring 12 months of documentation. I had to travel for work out of the country and couldn't see my doctor. I missed out on 2 months of documentation and my surgeon at that time wouldn't submit without 12 months. He stated that BCBS is very strict and quick to deny folks. My friend and her sister had United Healthcare and were approved after they first submitted the paperwork.