BCBS/IL PPO-Approval Requirements

Hello all! I have BCBS of IL -PPO. I reside in Georgia. I have called my insurance and the plan does cover wls.I spoke to 2 reps.(no exclusion) I had to be sure. Well I have statred my 6 month supervised diet(w/my pcp). I am on mnth 3.He supports me having wls. I have also found a surgeon in my area(2 girlfriends used him).I have had my cardiologist app.,pysch eval.,and blood work done. I only have to see the nutrisionist which I will do next month.My BMI is 46. I have not lost any weight on my diet. I am also on Phentermine.1st question-Should I be worried since I haven't lost anything?I am afraid that losing weight will get me denied since they may say I can lose on my own. If I dont lose they will say too bad we wnated you to lose to show a commitmet! Also They want 5 yrs. medical history supported by medical notes. Well I don't have that. I have been ovrweight my whole life. I have only been on my job for almost 2 yrs.Therefore I did not have health insurance for the past five years.. About four yrs ago I had my appendix taken out and I am trying to get the medical notes from that to show my weight from then.I think I may have about 3years worth(yr.03-05-07). My surgeon and pcp say they will talk to them(insur. company) if there are any hurdles and write letters. The surgean and pcp are very supportive.So I guess I wanna know can I be denied for not having the 5 yrs? Can they overturn if surgean is backing me up and the pcp as well? And should worry about losing too much or too little weight?
My bmi is 46 and I have mild sleep apnea(did the sleep study last month) and high cholesterol, joint pain(may be athritis awaiting results).Not to mention all my family is obese with a history of problems including heart disease, stroke,thyroid,and more. By the way I am 26yrs. old. I want to live a happy life. Thanks for listening.ANY advise is very very appreciated!I hear BCBS is TUFF!!!!!

I have that insurance and they are tough. i did not lost weight either for the first 4 months on my diet so dont worry. BCBS tried to say i needed more documentation for 5 yr history but my surgeon spoke to them and I was approved by them. Good luck!! I had my surgery this year at the end of march

BCBS is tough!  They told me the same thing, but primary physician and my surgeon reinforced the need for the surgery.  I was only 29 years old when I had the surgery three years ago.  I als had a BMI of 46, so I know how you feel.  You've already wasted important years of your life to obesity.  Stay on top of things.  I didn't have five years documentation of weight loss, but I did have medical history of my asthma, the steriods I had to use, the findings of the sleep apnea test, results from the endocronologist, all stating that my weight was extremely harmful to my health.  And they also stated that the excessive weight has caused many of the new conditions that I had acquired.  I almost gave up because it can be very frustrating.  Don't do that!!!!!  Talk to someone from BCBS to find out specifically what is required and hopefully your surgeon and his team will be able to summit enough information to back up the need for them to cover the surgery.  Summit any pertinent information that you can so that BCBS will deem your surgery medically necessary.  Let me know how things go cause I'm rootin' for you! Teneaha

Thks so mush for your response it sounds like you were in the same boat as me! I felt like I have some hope now. I switched my surgeans from the orginal one I had chosen becuase he really fights for you.So does my pcp.Surgeean told me flat out he knows how to deal with them (bcbs).A few people told me to forget about it becuse they won't approve wou 5 yrs. but you're proof they will.. I am gonna stay positive. Thanks a BUNCH!!!!!

I have BCBS of AL, but I think the requirements are the same.  I also did not have the 5 year history thing, but I could have my previous doctor provide a letter stating that as far as he had documented, I had been this weight from the start.  Don't get discouraged, because they try to make it seem harder than it is.  I had to jump throught so many hoops, but in the end it all worked out.  One caution though, make sure all of the pre-op stuff is PPO or you will have a seperate deductable.  I had my surgery at Carl Hosp. in Champaign, but Carl Clinic did the pre-op, and they are not a PPO prov. I now owe them an out-of-network deductable.