Question:
Who out there has been approved by BC/BS of Illinois, PPO for Bariatric Surgery??

I am waiting for my psych eval and then a letter will be sent to my insurance company. I wonder if anyone else out there had any problems getting approved for Bariatric surgery by BC/BS of Illinois, PPO. I am 30 with a BMI of 43 and minor other problems including joint and back pain, daytime sleepiness and urinary stress incontinence. There is a strong family history of heart disease in my father and my maternal grandfather who died of a heart attack in his 50s. I have tried many diets, some under medical supervision and others like weight watchers. I have currently been on phentermine for the past year which is now just preventing me from gaining any more, but I am not losing. Any info would be great. Thanks    — Carrie C. (posted on October 8, 2003)

October 8, 2003
I was approved by BC/BS of Illinois PPO within two weeks of submitting the request, back in February. I am 44 years old, had a long list of previous weight loss attempts, diabetes, high blood pressure, high trigycerides, and knee and ankle pain. So, our situations are not identical. Also, a lot will depend on the actual plan you have. For example, if your employer has excluded coverage for WLS, then you will have a different set of issues. Not all PPO plans are alike--the employer chooses coverage particular to their contract w/ BC/BS. The best thing is to wait it out, and appeal if you are denied. Best wishes.
   — Vespa R.

October 8, 2003
Try checking under insurers on this site. It will give you a list of people who have had WLS w/your same insurance and you can email them with your own questions. That's what i did, it helps alot.
   — vllgmz4

October 8, 2003
I WAS APPROVED AFTER 1 WEEK. THEY DID NOT GIVE ME ANY PROBLEMS WHATSOEVER. MY BMI WAS 40 AND I HAD MINOR CO-MORBITIES AS WELL.
   — ANDREWS65

October 8, 2003
I have BC/BS of Illinois PPO. After it was submitted they did it over the phone in 24 hours. I have nothing but good things to say about BC/BS. They were very fast in their approval and I am 5 months from open ryn and have lost 60 lbs.
   — Maureen C.

October 8, 2003
I too have BC/BS of Illinois (PPO) ... and my problem wasn't with BC/BS .. it was my COMPANY that had them write the exclusion for weight loss surgery. My surgeon at Northwestern, however, provided a medical necessity letter and I was approved within a few weeks. Good luck! LAP RNY 06/18/03 -65
   — Karyn B

October 9, 2003
I am waiting and waiting for them to respond. Check out my profile it will explain all the crap I am going through. My BMI is 41 and I have a few co-morbidities, but not the major stuff like Diabetes or Hypertension. I am worried that they are going to request a medically supervised diet before they will approve surgery.
   — Kara J.

May 31, 2004
bcbs of illinois now does cover bariatric surgery, it also covers abdominoplasty. you must meet certain criteria. you can go to www.bcbsil/medpolicy.com (i think) or call the customer service number on the back of the insurance card and ask for the medical policy website.
   — kimberly K.

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