BCBSM Why would there be different criteria for patients in who live in MI than those in IN?

Hello everyone, I could sure use some kind words from someone who understand insurance companies. Here is my story: I have BCBSM PPO through my husband's employer (Ford). I call the customer service # that is given to me by the UAW rep (800-482-5146) and they sent me a document as of March saying that with a BMI > 50 the supervised weight loss of 6 months is waived. I also have 2 documents from BCBSM stating this. However, at that # they tell me that I have to call a different customer service # because I live in Indiana (800-572-6860). When I call there, I am told that the criteria state 12 months supervised diet is needed. This is also what my surgeon's office got a letter back stating when she faxed information in to Anthem BCBS in KY (I have no idea why it would go to Anthem in KY). My question is how can BCBSM have two completely different sets of criteria for people who live in MI vs people who live in IN? It's the same insurance company no matter where I live (still BCBSM). I am very frustrated and confused.

Check with them again.  If I'm not mistaken the state of Indiana told the insurance companies that they could not require any program longer than 6 months.

Can you call the UAW rep and ask? Our insurance has been with BCBS of Texas, because that is where my husband's employer's corporate office is located, even though we live and work in Indiana. 

As for Anthem BCBS in Kentucky, one of my bills mentioned that, but my EOB showed BCBS of Texas...maybe the KY office is a billing site for this region? Either way, if BCBS of Michigan is your insurance company, since Ford is headquartered there, then BCBS of Indiana shouldn't play into it...definitely call the UAW rep and ask!!

Robyn,     It is a law in Indiana that 6 months is the max that can be required. The strange thing is why are you being told two different things since you do live in Indiana. Where does Michigan come into play? Is that where your husband works? If it is, then the policy is a Michigan policy and you will be held by Michigan state laws and what they do or don't allow insurance companies to require. It may be that Michigan state law allows insurance companies to request up to 12 months. If your husband works in Indiana, the 6 month law should be applied.  I agree with the others that you should call the UAW rep and ask them to intervene for you.   Best of luck, Sherri

Robyn

I had BCBS of IL. They required me to have 12 months. Even though indiana law states 6 months  they don't have to follow Indiana law because the headquarters of my husbands company is located in IL.

I called the insurance commission on it and everything but where the headquarters of the company lies that is where your insurance company and their rules also lies. 

 

Hope this is a help

Robin 

 

I think it makes the difference on where the employment is held. If you live in Indiana, but work in MI and get your insurance from MI, I would think MI rules would abide. I know in Indiana, they can only require 6 months of supervised weight loss though. 

Actually, we live in IN, husband works in IL, but the insurance is BCBS of MI.

At support group someone said that all BCBS is handled differently. We have Anthem BCBS and the company that has it written has different criteria than say BCBS Michigan. Some that were there said they had the same insurance that you do and that it was a big pain in the a-- to get approved. SO just keep fighting it will soon change. Michelle