BCBSM PPO PREAUTHORIZATION

My doctor had to request a preauthorization.  The only surgery I can have in his opinion is the VSG but Blue Cross requires a BMI of 50 and mine is 43.  How long does BC take to make a determination?  Will I be notified by BC of their decision?  Is there anywhere on the BC website where I can get some information?  When I call BC and get a representative they can't give me any information.  They are nice as can be but they just dont know.  At least they admit that they dont know and nowhere can they get the information.  Thanks for any advise. 

That is bs...ask for a supervisor..they can tell you....they are playin games...

I thought I had my WLS folder at home...it must be at work.  I know for RNY and lap band BCBS MI PPO no longer requires preauthorization.  Is it different for VSG?  For RNY/Lap Band anyone with BMI greater 40 that meets the guidelines qualifies (guidelines are 6 month physician documented  unsuccesful weight loss attempts, pass psych eval, pass nut eval, etc).   PM me.  I have it in writing from BCBS.  If you have a fax # I will fax it to you tomorrow from work, or send me you snail mail address and I will mail you a hard copy.   Good luck!  Keep fighting.  They expect us to give up so they don't have to pay.  But we're better than that :-)

Dana, I am having VSG and also have BCBS.  Mine is through GM, but I was told that they no longer do pre-authorizations.  My doctor told me to call BCBS and tell them the procedure codes for the surgery I was having.  these are the codes I gave them VSG procedure code 43843 Diagnosis code 278.01 They told me that it was covered.  Never asked me what my BMI was.  All I can say is ask your doc which codes he plans on using and then call BCBS. Hope this helps Bernice

Sorry to confuse but need the preauthorization because my insurance required a BMI of 50 for the VSG and mine is only 43.  Because of previous resections to colon and small intestines cannot have the DS or RNY.  The doctor does not feel that I would lose the weight that I need to lose with the lapband.  Sorry for the confusion. 

Dana, The information I have from BCBS states that for a BMI over 50, no medical supervised diets are req.  Preauthorization is no longer required regardless of BMI if you meet the other criteria.  I can fax you a copy or mail it.  Just PM me your fax # or address. Shawn

4 to 6 weeks is how long it will take. 

The VSG requirement is a BMI of 50 that is what he has to get an exception (insurance calls preauthorization) for. 

I have BCBS PPO insurance and had the sleeve done and my BMI was only 38. 

Physcian's office says for the VSG I need BMI over 50 and 6 months of supervised diet.  Called BC this morning they state BMI over 40 without comobidities and 12 months of supervised diet.  Thank god this is my 12th month.  I have appointment next week with physician for endoscope.  Guess I will have to talk with them again.  They have already sent in for an exception.  I really am not a patient person and this confict isn't helping either.