Question:
Blue Cross Individual Plans - no pre-service approval???

My surgeon's office sent a letter to Blue Cross to request approval and they answered with neither approval or denial. Apparently on idividual plans they don't do pre-service approvals, but as long as my BMI is over 40 at the time of the surgery I'll be covered. I guess I can go ahead and schedule my surgery, but sounds kind of risky to me. Anyone else have this problem?    — Jill I. (posted on June 21, 2001)

June 21, 2001
Well I have BC/BS federal and they told me the same thing, and I was uneasy about going with the surgery, not knowing if they were going to pay or not until AFTER the surgery, but, if you take a look at my page, I have written exactly what they paid and how much I had to pay out of pocket. I hope this helps. Good Luck...
   — s r B.

June 22, 2001
Please please please check your summary of benefits and read your exclusions and limitations to make sure there is nothing listed. No need to run the risk of a huge bill. Which BCBS plan do you have? What state?
   — Dawn R.

June 22, 2001
Make sure your Dr. office clarifies this, I have BC/BS and they would pay for three different WLS without pre authorization. However, my surgeon feels that I need a different procedure and they will not cover it.DS with commn loop longer than 100 cm. he was very surprised by this denial and I will contiue to fight the determination. I personally wish it had been found out after the prodedure. That way I could make payments to the DR, now if I private pay it will be up front. Good luck, Kathy
   — [Anonymous]

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