do you have bcbs of Mi?

Hi all -  I am not from michigan, nor have I ever been there in my life but somehow I have Michigan insurance through my employer.

Anywho....I was just told today after waiting almost two months for approval that bcbsm does not require pre-approval for wls. That if I meet all of their criteria, I just have the surgery and they will pay. Which sounds great and all...but my surgeon will not do the surgery without a guarantee that they will be paid.  Does anyone else have this insurance? How did you find a surgeon that would do your surgery on an IOU?  I've posted a few other places and some people are saying they just had their surgery and it was paid, others are saying they are still going through the process.... If you have an experience please share with me. Thanks.

I have MESSA which is a BCBS deal. They pay fats and correctly. My doctors love my insurance. kp

I think the fact that I'm not in Michigan is the problem.  You didn't have any problems with your surgeon taking your insurance, huh? Well hopefully i will get the same deal..

No problem. In fact, every time I flip my card to the receptionist I hear "CHA-CHING" and their eyes glaze over. BCBS is the best according to them. kp

I also have BC/BS of Michigan and they do not require pre authorization, just that you meet the criteria.  It was very easy but I did call and make sure about the facts and even got the name and ID number of the person answering the questions just to CYMA.  They paid very quickly (within 3 weeks) of my surgery.

Did you have 12 months of weights with your pcp? When I talked to the insurance company today, I talked to someone who was very helpful in telling me what I needed. And it said something about have a dr supervised or professionally supervised diet which i do have but not 12 months of actual weigh ins at the dr. office. My pcp wrote me an awesome letter stating everything that I have done and I wrote up a list of all of the diets, weights, dates and everything that I have been on in the past year and a half which he also signed off on. When I talked to the insurance girl she said this was okay and that i should include my gym membership form and a letter from the counselor that I was seeing at the time. However, the surgeon's office is saying this isn't enough....

I was in the same boat as you...except I am in Michigan and my husbands BCBS is from Texas.   This is what I had: 1) Dr's records included 14 months of weigh ins (monthly) but they also were kind enough to add my biweekly gym weighins to their chart (which cooresponded with their weights, except a pound or so...probably due to different scales).   2) Psych test 3) High BMI with high blood pressure (being monitored only at that time), infertility, depression (but on meds so it was controlled). 4) Paperwork the place I went through had my PCP fill out. My paperwork was submitted and I believe it was about two weeks when I received a letter from BCBS.  It was my approval letter.  But it did say that it would not guarantee payment, blah, blah, blah stuff.  However, I was told that even though it said those few words, that it proved you met the requirements and they would pay.   Hope that helps.

thank you, it does. However they wont send me any type of letter so I dont know if what i have is sufficient or not....

Just have your office send in all the stuff.  BCBS should send you a letter, even though it says it doesn't guarantee payment.  Atleast they did a year ago when I got mine.   When I got mine, I wasn't sure if it was my approval letter.  I called a few people (from the boards) and the next day called the office that did my stuff.  Everyone said it was my "approval" letter.

All I needed was a written diary of all the diets I've ever been on.  The doctor also saw me every 3 months and noted our talks about weight loss and diets and weigh ins.  I never got an approval letter from BC/BS, just a phone call from MMPC saying we could go ahead.