Rant On: BCBS-IL

mandilou · 05-21-2008, 09:00 AM

Thanks to BCBS-IL being completely backwards, I will have to drop out of the program.

I started the program with a local hospital, and have been going to my six month supervised diet appointments. Well, I got a bill for over $200 yesterday for ONE appointment. When I called the insurance company to ask why I was billed for an office visit, they claimed that they do NOT cover nutritional education unless I have diabetes. So... let me get this straight... THEY require a six month supervised diet, but THEY won't cover it? What the hell? They will cover diabetes, but NOT morbid obesity... which is ironic, really. I suppose in six months when I DO have diabetes, they'll help me out.

And so, since I cannot afford over $200 a visit to get my supervised diet, I am going to have to drop out of the program. Apparently, my doctor says not ALL BCBS-IL patients have had this issue, so perhaps it's just my particular employers agreement. But boy am I steemed. I seriously have so little hope now.

gigim · 05-21-2008, 09:20 AM

I HEAR you.....I have BCBSIL and I hate them, I am in the process of trying to get them to cover the Lap Band surgery, not the 6month supervised diet....What I did was 1. get my doctor to note he monitored my weight for 6months and a year or so ago I joined medical weight loss and I just ordered my records from them..Can you doctor put in your records that he monitored you for 6months????I would talk to him again about this....Also Weight Watchers, Jenny Craig,etc are accepted by BCBSIL.....Good Luck, Don't give up...Fight BCBSIL like I might have to do...Gigi

Apples2 · 05-21-2008, 09:31 AM

It would be worth a try to see if they will accept a different type of weight loss six month record such as Weight Watchers. It's worth a try and would be a lot less $ than the $200 per visit. Just a thought

msperson · 05-21-2008, 09:31 AM

go to your reg doctor and tell him put me on a diet and monitor me for 6 months! make sure he documents your progress and hopefully this will work! also can you use your surgeon that will do your surgery? i am using mine but my insurance covers it.

mandilou · 05-21-2008, 09:37 AM

Well, the hospital where I was planning on getting my surgery, as well as the other hospitals in the area, have an all-inclusive program. So you HAVE to see their nutritionists and stuff so that they have all the information. I'm going to start researching smaller clinics that offer the surgery, and perhaps seeing my GP once a month will be okay (cheaper still than WW, since I have a copay) for a pre-req fulfillment, yet I'll still have a surgeon to work with.

I'll be researching my options, you better believe it. My rant was more based on the idea that insurance companies are always complaining about how their premiums are going up BECAUSE people are fatter/sicker/etc. yet they aren't doing anything to help with PREVENTATIVE maintenance. It just doesn't make any flipping sense.

Thanks for the support and suggestions... I will take them all into account and see what I can afford!

msperson · 05-21-2008, 09:42 AM

some pay for viagra and i have heard gender reassignment surgery! go figure!

MTBiker · 05-21-2008, 10:14 AM

I was under BCBS-IL for years, and could get nowhere with weight loss, because they wouldn't cover anything. I even filed an appeal, which was denied to the the policy in effect.

Now due to a merger I am under BCBS_GA, which does cover Lap Band, and doesn't require a 6 month supervised weight loss! I am hoping for surgery in the next couple of months. However, I think the policies around coverage are mandated by the employer, not BCBS.

My suggestions would be to ask your doctor if there is a cost effect way to complete a supervised weight loss since it is out of your pocket. You could also try to file an appeal with your HR department.

Best of luck.