Question:
What is need for approval of BC/BS PPO Community Blue of Michigan

   — vickie C. (posted on July 1, 2000)

July 2, 2000
Hi Vicki! I just got approval from BC/BS PPO of MI, less thank a week ago!! They wanted a psychological exam, last 3 months of diet doc's that's all they required from me. My surgeon had me take a Sleep Apnea test, after that I got the clearance for surgery. If you have any questions please email me. GOOD LUCK! *HUGS* JAY
   — Jason B.

July 2, 2000
I have BC/BS of Michigan PPO and was told this is not the same thing as Community Blue...so I can't tell you what your insurance needs, but just call them and ask. Or, ask your surgeon's office. I'm sure they have dealt with this insurance and can help you get everything together. My surgeon's office gave me a list of stuff to send to them (all the medical records I could get my hands on and my diet history) and they took care of the rest. My insurance also required a psych eval (I think most insurances do). Basically you're trying to prove to the insurance company that you've tried everything to lose weight, it is medically necessary for you to lose weight and that you know what is involved with the surgery and do not have any psychological problems. Good luck to you.
   — Kellie L.

May 11, 2001
Hi there! I have Community Blue myself...and basically the easiest way to find out EXACTLY how you qualify is calling them directly. It may differ based on what procedure you are considering too. So the best bet would be to notify your surgeon's office to find out the procedure code and while you are at it...the diagnose code too. Then call BC/BS and ask them directly to find out (based on the codes) if you are covered or not. Usually it is that you have to be over 100 pounds over weight, over the age of 18, and needing a letter from a therapist and/or your doctor stating it is medically necessary. I have been told that you also may need a "second approval" exam by another doctor and a letter from him as well. So far with my experience...I am covered and have had no complications at all. Another tip too that you should take in consideration: make sure your surgeon is in-network! Bascially this type of insurance accepts this type of surgery and takes a about a day for approval which is most of the time. Good Luck!
   — [Anonymous]

Click Here to Return