Blue Cross/Blue Shield PPO of Michigan

Hello, I will be going to a Bariatric seminar later this week. I have done a lot of research and I am pretty sure I want to have this surgery. I was wondering if anyone here has dealt with BCBS PPO of Michigan, and what I might expect? Will I need approval from a doctor? Also, I do not have any documented weight loss attempts through a doctor, although I have tried hundreds of times on my own. Will they approve me? I have a BMI of over 54.2, does that play a factor in BCBS's decision? How long does an approval usually take? Will my surgery date be a long time off? Sorry for all the questions, I am just curious and anxious now that I have come to this decision, as I am sure you all understand! Thanks for your help! MN

Hi, I have BCBS PPO. I had to have documented weight loss attemps for 12 months and was told they had to be documented by my doctor. Some of these visits were just my PCP asking me if I was still exercising...those counted. Depending on where you are going to have surgery.....some have a program above and beyond what the insurance company requires. Try to get as much information together as you can. If you visited your doc for something and weight loss was discussed, find out if it's in your records. I would also call BCBS and see what the requirements are now. Good Luck!

I would definetely call your insurance company- everyone's plan is different..ask then if weightloss surgery is a covered benefit and also what is their criteria for the surgery. Good luck! SHannon

Thanks for the responses. I did give the insurance a call tonite, and the biggest thing was needing six months of supervised weightloss/dieting. I don't have any documentation of that, although I did go through a program at the YMCA, but that was back in 1998. I doubt that will count.

There is NO way around that diet documentation. Insurance will not approve your surgery until you have the documentation in place. Make an appointment with your doctor and get started today. TODAY! BCBS should be able to provide you with a list of what is required regarding the diet documentation. I also have BCBS PPO and there were several things --- nutrition counseling, physiotherapy (exercise), behavior modification, pharmatherapy (diet meds Rx), etc. Find out the exact wording, take it with you to your doctor and get started with the documentation. And make sure he writes everything down. I'm halfway through my diet documentation (again!). The first time around my doctor didn't bother writing anything down -- then refused to alter his notes in my medical records. And of course I couldn't get approved for the surgery. So I had to start over from scratch again. I wouldn't wish this experience on anyone. So start now with the diet documentation and continue your research and appointments. Even if you decide not to have the surgery, at least you have the documentation in your medical records in case you change your mind. Don't wait until you decide yes-or-no on the surgery to get started on the diet documentation. Good luck! Pam

Hi MN, I also have BCBS PPO of MI. I was approved within 2 months after getting that insurance. ( 4 weeks was waiting for the doctor to get back from vacation to sign the letter grrrrrrrrrr!) I've heard that some have been approved within 4 hours of submitting a request. She is in my support group. You'll need a letter of 6 - 12 month doctor supervised diet attempts, weather it's medications, exercise, different food diets, doctor visits discussing diet/excessive etc. And a specifically worded letter from your doctor. Did you know you can go to the BCBS website and register there, type in the info on your card and it'll show what it covers, what is required for that particular procedure and what doctors and facilities are "in network" and what the costs would be? Give it a try! And good luck!

I had a great experience with BCBSM. You can read my pre-op profile for more info, but like another poster said, every plan is different. I know BCBS in general is great at approving. Good luck.

Hi, I have BCBS/PPO. I needed 12 months of documented weight loss from my primary care doctor. Very, very, very, smooth sailing with BCBS. I couldn't have asked for a more helpful company to work with. If you read my profile you will see how quickly I was approved and got surgery. The best thing I ever did for myself...best of luck to you. I would call BCBS and see what type of bariatric surgery coverage they have on your policy. They will give you all the details of what you must have in hand to get approved. Hope it works out for you!

Hi MN, Get EVERYTHING you have pertaining to weight loss! Go to the Y. M. C. A. see if they may still have any records of your weight loss attempt. If you can think of anything get it in writing. Did you get weighed when you went to the Dr. office? Get that. B.C.B.S requires 6 to 12 months of supervised weight loss attempts. Start right now ~TODAY! Call your P.C.P. and make an appointment Get in there A.S.A.P. have him/her write a letter of necessity for weight loss surgery. I wrote my own and my P.C.P. copied it onto her letterhead. I'll send you a copy of it. Remember the insurance companies like to play games with this and will do everything they can to discourage you. Don't let them do that! If you give up then you will never get this life saving/ altering surgery. It took me a year to get my final approval and have the surgery. There were times I almost gave up. It was the people here that encouraged me to stand tall and fight for my right to have this surgery. I encourage you to do the same. Honestly it is the best thing I have ever done for my health. I have lost a total of 216#'s. I had a couple of complications but would do it again in a heartbeat if I had to. The last 17 months have been the best in my life ~and it just keeps getting better! Feel free to go to picturtrail.com and look at my pics. In the member name bar on the right key in oldelderlylady. I have lost about 15#'s since the last pics were taken (skydive). Best wishes on your journey. May God bless you, Annette

Thanks for the info, I will be contacting the YMCA to see if they have any records. I never thought of that, but I was with them for quite some time. I took a look at your pics and they are great, congratulations! I hope to be where you are someday. If you could send me a copy of the letter you mentioned I would really appreciate it. My email is [email protected] Thanks!