Approval Blue Cross Blue Shield of Illinois

wannababy · 09-10-2008, 02:34 PM

I just wanted to come on and let everyone know that I received my approval today from Blue Cross Blue Shield of Illinois.... I want to post my situation, so that anyone pursuing this can see a positive outcome from BCBSIL.

I am doing to the Realize Gastric Banding Procedure. I have had a BMI around 40-48 over the last 5 years, have tried several diets over my lifetime. I don't really have any severe comorbities, except infertility issues and elevated blood pressure. I had about 12 months of documented Weight Watchers journals, but still had to do the 6 months of medically supervised diet/exercise. I started that process April 25, proceeded to go in May, June, July, Aug, and my final visit Sept 2nd. This was accepted as 6 months, although it was 6 visits, not 180 days. My Dr was great about making good notes in my chart, ie: vitals, weight, what I was doing, eating, exercising, what I should be doing, etc; and I went to the Dr specifically for this process. My information was submitted to BCBSIL in August to see if they would accept my Weight Watchers as part of my 6 months, and they replied that I needed one more month of notes, so that was completed Sept 2nd. That information was faxed on Friday, and I received my approval today, the following Wednesday. This process could not have gone smoother in my opinion. I think my very helpful Dr.'s office, Surgeon's office, and persistance were the key parts to this success.

I am having my surgery next Thursday, Sept 18th.

That is my story. Hopefully this can help someone going through the beginning stages of the whole process. Good luck to all of you.

Amy

LISAMARIE1158 · 09-10-2008, 04:17 PM

Hi Amy and Congrats to you..l too have B/C and l got my approval several weeks ago, with my surgery 9/12 Just wanted to let people know that they might need to call B/C to get the approval..l called them daily until they approved me..well yesterday in the mail, l finally got the letter with the approval..So, it was 6 weeks of waiting just for the letter to arrive..To all that may be waiting, CALL THEM

*slim* · 09-10-2008, 05:32 PM

Quote:

Originally Posted by LISAMARIE1158

Hi Amy and Congrats to you..l too have B/C and l got my approval several weeks ago, with my surgery 9/12 Just wanted to let people know that they might need to call B/C to get the approval..l called them daily until they approved me..well yesterday in the mail, l finally got the letter with the approval..So, it was 6 weeks of waiting just for the letter to arrive..To all that may be waiting, CALL THEM

That's what I did too. I was approved on Aug. 25, but still haven't gotten my letter. I called again yesterday and was told that the person that TOLD me I was approved by email, didn't do anything to send that approval out in letter form. I am still waiting, but my surgeon's office accepted the email from Blue Cross in order to schedule my surgery.

Good luck to both of you on your journey!

Tamihott · 09-10-2008, 06:17 PM

Congratulations! Like I said before I think BC/BS is finally jumping on board with approvals. I was denied once and then approved, but for me it was pretty smoothe too. I am having surgery the 17th. Good luck to us! Tamara (starving on her pre-op liquid diet)!!!!

JUSTTIRED · 09-10-2008, 07:54 PM

Thanks for the encouragement, I am in the 1st month of the supervised diet, and it looks like a long road. I know in my head it will go fast, but <sigh> Its going to be a challenge. My pcp will do the 6 month visits and bill for another "code" so it gets covered. My surgeons office suggested that. Just a little fyi. Good luck to all...and keep the faith.

God Bless

Just Tired

wannababy · 09-10-2008, 08:29 PM

I start my preop diet tomorrow, so I will soon know what you mean!! My preop diet consists of broths, water, crystal light, sf popsicles, basically nothing with calories. For 7 days... Is yours about the same tamihott??

Tamihott · 09-10-2008, 11:20 PM

I can have broths, sf pudding, sf popsicles etc, but I can have oatmeal or grits and cottage cheese, but my diet is two weeks. It is super hard at first but gets alot easier. I am full but never really satisified. I drink alot and that seems to help the most. Good luck! Tamara

We will definitely have to be each others support, since we will be banded just a day apart!!

jaimefletcher77 · 11-28-2008, 08:45 PM

Hi All,

Just starting the process. Called the surgery center for info today. They told me about the hoops for BC/BS of Illinois. I guess that is good so I don't jump in too fast but I hate waiting for so long;-(.

couple of questions:

1. Did any of you lose weight during the 6 months? I am at about 37.8 bmi which is borderline so this sounds weird but I am worried about losing 20lbs like I always do when I diet and not qualify.

2. Does the diet have to be a controlled program like WW or can you just say you are doing South Beach or the billion other ones that we probably all tried?

Thanks for your help!
Jaime;-)

RobertaMeikle · 02-16-2009, 07:07 PM

They are supposed to take your BMI at the time you START the 6 month dieting...not at the end.

Exarmy30 · 03-08-2009, 10:15 PM

Hey thx for all the 411 guys! I just hired out to a company that has BCBS-IL and need another 2 mos. b4 my insurance is effective, then the company has a 1 year with the company exclusion on gastric band. (Idont think they cover bypass though) FYI So Ive got a long wait but im sure itll be worth it!

PWoo10 · 06-30-2009, 11:32 AM

My doctors office told me about how hard it is to get BCBS Illinois to approve. She told me I would be denied immediately and then she would call and have a peer to peer talk she has hopes that will work. Nothing has been submitted yet as she is trying to collect as much as possible on my last 5 years of medical history. I have a BMI of 38 so that is why she said it will be hard but since there is a will there is a way. I guess this is one of the hardest insurance there is to get approved. Thats my luck!

Divis · 06-30-2009, 03:25 PM

Hi Everyone,
I received a letter yesterday denying my claim. I just got off the phone with BCBS and I was informed that my Doc did not include enough info and that I needed to have my 5 year medical history of Morbid Obesity by medical record submitted. Here is my problem, I just got BCBS 2 years ago and prior to that I had Kaiser. But Kaiser never addressed my weight. I went and got a personal trainer and did stuff like that but I never discussed my weight with my doc until two years ago. Does this mean I have to wait 3 more year before I should re-apply? Is there any other type of info I can submit on my behalf? Did you all submit a 5 year "medical" history? I've been over weight for about ten years now and so far I've been fortunate enough to avoid getting diabetes and high blood pressure. But now I'm borderline and I'm afraid if I wait 3 years I will develop them. I need help!!!! I'm sooooo bumbed

PWoo10 · 07-01-2009, 11:34 AM

Divis, do you have medical documents showing you have had a history of obesity for 5 years? Perhaps doctors records? You don't have to wait another 3 years as long as you have records.

KayleighsMommy · 07-01-2009, 11:48 AM

Quote:

Originally Posted by wannababy

I just wanted to come on and let everyone know that I received my approval today from Blue Cross Blue Shield of Illinois.... I want to post my situation, so that anyone pursuing this can see a positive outcome from BCBSIL.

I am doing to the Realize Gastric Banding Procedure. I have had a BMI around 40-48 over the last 5 years, have tried several diets over my lifetime. I don't really have any severe comorbities, except infertility issues and elevated blood pressure. I had about 12 months of documented Weight Watchers journals, but still had to do the 6 months of medically supervised diet/exercise. I started that process April 25, proceeded to go in May, June, July, Aug, and my final visit Sept 2nd. This was accepted as 6 months, although it was 6 visits, not 180 days. My Dr was great about making good notes in my chart, ie: vitals, weight, what I was doing, eating, exercising, what I should be doing, etc; and I went to the Dr specifically for this process. My information was submitted to BCBSIL in August to see if they would accept my Weight Watchers as part of my 6 months, and they replied that I needed one more month of notes, so that was completed Sept 2nd. That information was faxed on Friday, and I received my approval today, the following Wednesday. This process could not have gone smoother in my opinion. I think my very helpful Dr.'s office, Surgeon's office, and persistance were the key parts to this success.

I am having my surgery next Thursday, Sept 18th.

That is my story. Hopefully this can help someone going through the beginning stages of the whole process. Good luck to all of you.

Amy

Amy,

Congrats on your approval.

I just hate, hate, hate BC/BS of IL.

I was one of the people who said "screw it" and went ahead and paid. I had a severe hernia that had to be addressed, and was not about to have 2 surgeries. I am always happy to see people that were able to do what was needed to have BC pay for their surgery.

Best of luck on your upcoming surgery...I'm sure you will do great with your new little friend for life!!!

Divis · 07-01-2009, 11:22 PM

Quote:

Originally Posted by PWoo10

Divis, do you have medical documents showing you have had a history of obesity for 5 years? Perhaps doctors records? You don't have to wait another 3 years as long as you have records.

I have been to the doctor for debilitating back pain for about eight years now, but never for my weight. I don't know if I can just get my records and show them that I was over weight then too. Would that count?