Criteria for BC/BS HMO ILLINOIS

Can any of you share your experience with BC/BS HMO ILLINOIS?  I know that I have to see a nutritionist every month for 12 months without missing an appt., but beyond that, my Dr. hasn't given me any other information on the requirements.  I did have my initial blood work done a few weeks ago, and I have my appts. set up with the nutritionist.  Is there anything else I should be doing right now?  I don't want to mess this up because I didn't have all of the information.  Also, does anyone have any tips on how to get through this without any complications from this insurance company?  Thanks Much, Vicki

Well, actually it will not be the doctor that will give you the requirements but the insurance company. A doctor's office cannot keep up with all the requirements with each policy for each insurance company. Give your ins. co a call and ask them what the requirements are, if possible get it in writing.  As far as getting through it unscathed is to make sure that you keep the appointments with doctor weigh ins and with the NUT and keep good documentation of all your paperwork and times you call the ins. co. Everytime you call your insurance get a contact name and direct number to the person. The best thing is to have one person that becomes your liason at the ins. co and keep going back to him or her. Be sweet as possible because bees are drawn to honey easier than to vinegar. Sometimes it will be hard to be nice but it will get you further in the end. Christine

 

Hello Vicki,  I had to have documents on dietion and activities and monthly visit with doctor after the visit and also weight loss and gain for 5 years, and showing obesity for 5 years.   Also your illnesses.  But I must say it isn't always the same for the same insurance company because sometimes your company you have the insurance with may have other thing want or don't need.  I would call them and ask just what they and wanting from you in order to have the surgery. Lisa B

Thanks to both of you for your responses!  When I called BC/BS and asked for the criteria, they told me that I have to get it from my Dr., and when I asked my Dr. she said, just make sure you set up 12 months worth of appts. with the dietician, and don't miss one.  I just had a feeling that I should be doing more then that, and I don't want to find out 12 months from now that there's something more I should have done.   I am going to call BC/BS back and ask them again.  Maybe the first time I called I just got someone who was to lazy to get the info for me .  I do agree that being nice will get you far, so I will kill them with kindness, and be on my best behavior (like I was when I got pulled over today for not wearing a seatbelt, I was to humiliated tell the officer that the seatbelt doesn't fit around me, but I said "Yes Sir",  "I know sir", I'm sorry sir", and I managed to get away with just a warning!)  Oh I can't wait until seat belts fit me again! Thanks Again for your responses! Vicki

I got the BIGGEST run around from BC/BS and you are smart to get a jump on it. After completing the 12 month, I was informed it was not enough!! This is what is in my profile as to thier criteria back in Nov of 2005. But do call them and get the answers YOU need!!! Good Luck! Because of my run-around I have had several people contact me about the 12 month diet and what that REALLY means. I have spoken to BCBS in detail and thought this might benefit others who are just starting on their journey and need to complete it. If your policy states you need a physician supervised diet - this is what they really mean. (at least mine did anyway. Best bet is to ALWAYS check with your provider at every step along the way to make sure you are meeting their requirements) --Each visit must be on a separate sheet and list your current weight and vital signs (meaning blood pressure, pulse, whatever else,etc). The doctor must also make notes about your diet and exercise within that period of time as WELL as any lifestyle changes within that time (like taking the stairs instead of elevator and switching to whole wheat bread or low fat milk- stuff like that) --You MUST see the doctor (or a nurse practitioner) EVERY MONTH for 12 months in a row. You can not skip a month and you can not just go in for weight checks, you must review your plan with someone each time and they must write PROGRESS NOTES on the chart. Your weight (and issues resulting from your weight) must be the ONLY thing discussed at the visit and noted on your chart. --They want you to see a nutritionist at EVERY visit. The nutritionist must document what was discussed and goals for the next month. --They also want you to see a physical therapist at minimum every three months on the plan. (I asked if the YMCA would be OK for this and she stated that if I had someone SIGNING off on my cards that I was there and listed the beginning and ending times that would probably be OK) --They want you to see a psychologist at minimum at the beginning and ending of the 12 month plan. --Ideally they would also like you to be on some kind of liquid diet plan or weight loss drug. If your PCP decides that is NOT safe for you then he must STATE WHY he feels that is not a good option in the chart.

Wow, Thanks for your response.  I am just blown away by all that you had to go through.  Thank you so much for your input.  I will be on the phone with them tomorrow! Blessings, Vicki

Well, they never DID approve me. I got a new job with new insurance and was approved within 6 weeks! Good luck with them - just stick with it and eventually it will happen.

you can go here BC/BS requirements   This should help answer any questions.  Just make sure you read your rider for your coverage.

Rachel, Thanks so much for providing the link to the BC/BS page.  I have an appt. on the 29th to start the 6 month diet and will bring a printout with me so I can make sure that I do the right things. Char

It took me 15 months, several denials and finally a direct appeal where my doc and the insurance doc hashed it out over the phone.  I was finally approved and am scheduled for 6/29.  My doc said the insurance wanted to see some weight loss during the supervised diet.  The moral of my story is don't give up, even if you get denied at first.  Good luck!