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Reminder: A Second Surgical Opinion is Required for City of Chicago BCBSIL Members

Posted March 28, 2018

Blue Cross and Blue Shield of Illinois (BCBSIL) members with the City of Chicago alpha prefix CTY on their member ID cards and the group numbers 195500, 195501 or 195502 are required to call Telligen to obtain a second surgical opinion before having any of the scheduled surgeries listed below. Once the member calls Telligen to start the second surgical opinion review, the process typically takes at least three weeks to complete. 

This requirement applies to scheduled surgeries in the following areas:

  • Hip/knee/shoulder
  • Neck/back/spine
  • Gallbladder
  • Uterine/vagina/cervix
  • Gastric bypass

This requirement does not apply to surgical procedures performed if the member was admitted through the emergency room for emergency surgery. 

Although it is the member’s responsibility to obtain the second opinion, a provider may contact Telligen to start the second opinion process. The provider is responsible for obtaining preauthorization for medical necessity for the surgery. 

While there is no charge for the second opinion and the member is not expected to travel or be examined to complete the review, if Telligen is not contacted before the scheduled surgery, BCBSIL will not cover the surgical expenses and the member will be responsible for those expenses. The second opinion review process takes at least three weeks to complete. 

The benefit of this requirement is that the member will receive a confidential written report of the second opinion related to the proposed surgery. The member makes the final decision on how to proceed with the proposed treatment plan. Telligen will not share any information with the City of Chicago, the member’s treating physician or BCBSIL other than to verify that the member met the requirement of the second surgical opinion. Members may call Telligen at 800-373-3727. 

Always refer to the member’s ID card to verify prior benefit authorization requirements and appropriate contact information. Checking eligibility and benefits electronically through AvailityTM, or your preferred web vendor portal is strongly encouraged. 

This reminder can also be found as a Related Resource on the Prior Authorization page and on the BCBSIL Payer Spaces/News & Announcements section of Availity.com

Telligen is an independent company that provides Utilization Review/Case Management/Disease Management/Maternity Management to BCBSIL. Telligen is wholly responsible for its own products and services. BCBSIL makes no endorsement, representations or warranties regarding any products or services offered by Telligen.  

Checking eligibility and/or benefit information and/or the fact that a service has been preauthorized is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered. If you have any questions, please call the number on the member’s ID card. 

Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.