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Update: City of Chicago Discontinuing Second Surgical Opinion Requirement Jan. 1, 2020

Posted October 24, 2019 (November 19, 2019)

This notice is being updated to reflect that beginning Jan. 1, 2020, providers will no longer be responsible for obtaining benefit preauthorization for surgical medical necessity by calling Telligen. Gastric bypass has been removed from the list because it will continue to require a Telligen benefit preauthorization after Jan. 1, 2020.

Beginning Jan. 1, 2020, the City of Chicago will no longer require their employees with Blue Cross and Blue Shield of Illinois (BCBSIL) insurance to get a second surgical opinion from Best Doctors or benefit preauthorization from Telligen before having scheduled surgeries in the following areas:

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

Providers will no longer be responsible for obtaining benefit preauthorization for surgical medical necessity by calling Telligen at 800-373-3727, and the additional Best Doctors mandatory second opinion won’t be required. As a reminder, these procedures are still subject to BCBSIL medical necessity review. Check BCBSIL’s Medical Policies for more information, if needed.

If an above-listed surgery is scheduled through Dec. 31, 2019, it will continue to be the member’s responsibility to obtain the Best Doctors second opinion, which can take up to four weeks. A provider may contact Telligen to start the second opinion process.

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 provided 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.