In great need of help & advice

My papers were sent off for insurance approval..needless to say...they answered back that they needed more info.More information was sent....and now they have once again responded that they need more info. Now, depend on who I talk to I get different responses. My insurance carrier, BC/BS PPO..say it isnt a denial....is just simply they need more information to make a judgement. But my surgeon's staff says its a denial...and I should file an appeal.My PCP is totally in my corner and is rewriting-in his terms the STRONGEST LETTER he has ever wrote! BC/BS told me they wont send me a denial letter because I havent been denied, my surgeon's office staff said I should be recieving one. With all the confusement...I am trying my damnest to either force a denial or approval letter. My surgeon's staff has always been honest with me and has always went up and over the call of duty to help me. They suggested that I write a personal letter to help my case...anyone has any suggestions?

I had bcbs ppo and they ask for more info but I also got a denial letter a wk later barix just resubmited what they were asking for and the I was appproved I never has to write a letter.

BCBSM no longer requires precertification for surgery so I'm a little confused. Where does your surgeon work out of?

Real Weight Loss Solutions.....I have an excellent doctor, Dr. Schuhknecht..and his staff has been more than amazing...I do know that BC/BS PPO no longer requires pre-approval...I was told at my surgeon's office that they do seek pre-approval to guarantee payment. The one lady name Chuckie, was helping me is now out for an undisclosed peroid of time. Now Annie, who has been great, is helping me now. I really dont know what to put in the letter..since now I feel this might be my only chance. i dont know what to do.

Hi, I to just sent my papers in for insurance approval with bcbs ppo what did you mean when you said they no longer require pre-approval? Is this something that would help me out? Thanks, tammy

Tammy, BC/BS PPO no longer requires pre-approval...but they do ask for documented weight loss attempts,etc..a few years ago pre-approval was required. However, most doctors will ask BC/BS PPO to pre-approved the surgery...so its a guaranteed payment. There have been times of the insurance company not paying after the surgery was performed, so to give the doctor a good leg to stand on..they ask for preapproval. When I got my benefits book thru my employer..wls was a 100% covered benefit and my BC/BS PPO required no pre approval if certain requirements were met. ex BMI over 40, 100lbs over weight, documented by physcian of weight loss attempts,etc.

Many times I have read on this board the BCBS PPO doesn't require pre-approval. This is not exactly true. You must submit all information and still meet their requirements, they simply don't require a ton of support documents. This is why it is important to have your paperwork, supporting documents and go to a Bariatric Center of Excellence. I was approved and had surgery within four weeks of sending in my documentation. I did have all of my information together, clear and concise. They didn't require any supporting documents from my PCP. BCBS PPO is very nice to work with, you still must be prepared and have your answers and docs in order.

Hi Marc...do all people who have BC/BS PPO must go through a Bariatric Center of Excellence?...I was under the assumption that I could go to any doctor in my network.