I am going through hell to get an approval with a BMI of 57.8? PLEASE HELP ME!!!

I have BCBS of MI PPO. My husband has this through his employer (Ford Motor Company). I have called the customer service number and gotten jerked around several times. I have a surgeon and her office has sent in a request for predetermination. I was told by several people here on OH that as of January 2008 bcbs requires 6 months of supervised weight loss but with a BMI over 50 that is waived. So why is it that I get a letter back from Anthem BCBS saying that I need to fax in 12 months of supervised weight loss documentation? Not even 6 but 12 months? I called the customer service # yesterday and asked to speak with a supervisor and was told they were on lunch. I called this morning and asked to speak with a supervisor and was told "We can't get you one directly, but I will put your name and # on a list to be called by a supervisor in 24-48 hours." I am very frustrated and completely mentally exhausted. I am in tears about this ordeal and needs help desperately! Please someone help me?

Each employer plan get's to pick and choose  how they want their benefits to be administered.. If they don't specifically choose a benefit they will then be given the administrators (that would be the insurance carriers) generic benefit  or they can choose to specifically exclude the benefit (as in the case with my employer). I don't have BCBS  of MI nor am I familiar with their plan... But simply by what your saying it sounds as though BCBS's standard benefit is a 6 month supervised WL program... whereas Ford specifically choose to have a 12 month supervised WL program.. Keeping in mind that WL surgery is costly, and this will dramatically cut down on the number of surgeries they are paying for..  Here's a few suggestions...  1- ask for a supervisor call back and give your #...  2- review the benefit booklet that should be given to your husband during open enrollment. There you should see any benefit limitations such as the 12 moth supervised WL program requirement.. and, if you can't find anything there..  3- contact the benefits department at FMC.. Their benefits person there should be able to 1- advise you of the benefit and 2- become a liasion with the insurance carrier to get this resolved for you..  Good luck and keep us posted.

Ah, frustration with insurance; I think we all experience it to some degree.  I'm sorry you're getting such a high dose...   Regarding your first question, about a 12-month supervised program instead of a 6-month supervised program, it may be that your insurer has changed their requirements.  When I had my surgery about 2 1/2 years ago, my insurer did not require any supervised diet, but now they require 6 months.  So this is something that can be changed and unless you are seeking approval, you would not know about the change.   I know it's hard to wait, but I'd suggest waiting the 48 hours for a call back from a supervisor.  If you don't get a return call, then I would encourage you to call back and calmly demand to speak to a supervisor; refuse to hang up until you speak to someone who can help you, even if it means you have to be on hold a long time.  Be kind and calm when you are talking to the reps; although you may be frustrated by the process, you will get a lot further with them by being super-nice than by venting your frustrations at them.   Once you learn what your insurance requires, follow the requirements to the letter.  I've read posts by folks who missed one weigh-in during a 12-month pre-op diet and they had to start over again.  So make sure you understand exactly what your insurance needs and that you do exactly what's needed.  It may be a slow, frustrating process, but it will be worth it in the long run - trust me.   One last suggestion - you may want to cross-post this entry on the Michigan board to see if anyone there has experience with BCBS... Good luck on your continuing journey.   Kellie

I have BCBS of CA PPO and they require 6 months. Each state is different and it depends on what plan you or your company choose. I agree with the one person that said you should review the book that was given to your husband during open enrollment. There should be a website also that would give you that information. Ask your husband to check with his HR department to find out what the website is.

I have BCBS /Anthem of IN.  I had to produce 6 months worth of records.  My Dr sat me down and we went back 10 years and ratteled off every diet I had ever tried - Meaning the ones he did not supervise - All OTC diet pills, the time I tried slim fast meals ect...  It worked.  Best of luck and try to get your PCP to do this.