I'm so bummed

KayleighsMommy · 05-01-2008, 11:44 AM

I just HATE BC/BS of IL!!!

I just spoke to my doctor and found out my sleep study results came back as mild apnea. I guess this is good news, even though I am probably going to have to pay for the test. I told him I got a letter from them stating one of the prerequisites is a 6 month diet. He told me even after the diet, they may deny me..jumping through all theri hoops is not a guarantee.

I talked to him about my need for hernia surgery (he was planning on fixing my incarcerated hernia at the same time) I asked him if we can put the Lap Band into insurance as a procedure secondary to the hernia repair (assuming, of course, they

consider a hernia repair "medically necessary") I also questioned him about my doing a self pay on the Lap Band portion of the surgery. He told me the actual Lap Band hardware is $3400.00

He is going to check with the hospital today, and see what (if anything), can be worked out. I'm not going to hold my breath.....

Onnie67 · 05-01-2008, 12:04 PM

Hang in there!!!! it is a pain in the butt...but try calling BC/BS and asking them to send you the requirements in the mail....i called my insurance and they did that for me no problem...this way you have your ducks in a row...
I am from IL too...where are you having your surgery at??

newimage · 05-01-2008, 12:05 PM

I hope all goes well.

KayleighsMommy · 05-01-2008, 12:10 PM

Quote:

Originally Posted by Onnie67

Hang in there!!!! it is a pain in the butt...but try calling BC/BS and asking them to send you the requirements in the mail....i called my insurance and they did that for me no problem...this way you have your ducks in a row...
I am from IL too...where are you having your surgery at??

I am actually in CO, just moved from MI. My husband works for AT&T and BC/BS IL was one of the very limited choices for insurance.

The most annoying thing is that when my surgeons office first called, they were told that bariatric services were covered.. no prerequisties, no copay, no deductible. Now they expect me tho jump through flaming hoops in the hope that they will deign to authorize this (in my mind) potentially life saving surgery.

tweety63 · 05-01-2008, 12:53 PM

I had bcbs hmo of il did 12 mths. supervised diets and visits they tried to deny me .I appealed it and the approved it . Mild sleep apnea high cholestrol joint pain. Don't give up !!!!!!
Colleen

Onnie67 · 05-01-2008, 01:07 PM

UGHH i am sorry! I thought you were in IL...
It bites having to go through all the hoops...i hope you get the answers you need!!