Question:
Has anyone else been recently denied a preauthorization for WLS from

BCBS Federal Employees Program due to a policy change effective June 12th where they will no longer "precertify" the gastric bypass? My doc is hesitant now, about scheduling me for my surgery because BCBS will no longer precert it, meaning there is no guarantee of payment ... Anyone have any advise ??    — Donna H. (posted on June 19, 2000)

June 20, 2000
Yes, I was denied the PRE-authorization from BCBS of Michigan. In MI they stopped pre-authorizing at the end of February. It was a "have surgery and pray they pay". My doctor had me sign a form saying I would be responsible for the charges if BCBS refused. Happily, about a week ago, I got the paperwork that they had paid!!! No extra questions or requests for more info. Good luck
   — Cindi W.

June 20, 2000
I had BC/BS Federal and had my surgery in April. The doctors office sent in my inofmration and about a week letter we both received a letter stating that they would pay at a 90% because I was using a plan doctor. This pre authorization was in writing. Of course we did get a precertification 2 days prior to surgery. But i would have felt just a comfortable without it due to the letter they sent approving the procedure. My hosiptal bill alone was $24,985.00. They paid all but $200.00 which was my private room. WLS is covered in the handbook and I'm sure it's medically necessary if you qualify for WLS. Best of Luck call BC/BS and discuss this with them or have you human resources office call for you.
   — ann A.

September 1, 2000
I also have federal BC/BS, and my husband called them to see if they have recieved the packet from the Dr.s office for pre-certification for surgery, and they said that they have not recieved it, and the told him that they no longer do pre-certs any more, so now I'm really confused, and wondering if i'm going to be able to have surgery, I do not want to end up paying for my surgery.
   — Melissa R.

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