Does anyone work for BCBS of MI that can help me?

Question

I have been told by people at obesityhelp.com who have the same insurance as me that in January of 2008 bcbs including MI made a change to weight loss surgery criteria stating that 6 months of supervised weight loss is required, but if your BMI is over 50 then it's waived. I have also heard that BCBS MI doesn't do preapproval, that you go ahead and have it done and then they process it. My surgeon's office sent in a letter in and I got a letter back from Anthem saying that 12 months of supervised weight loss needed to be faxed in. I call customer service and nobody seems to know anything about a change made in

January 2008. I ask for a supervisor and I get "We'll put you on a list to be called by a supervisor in 24-48 hours" Why am I being jerked around so much?

Answer 1

You should have a book from BCBS that tells all about what they will cover, won't cover, and what restrictions are put in place. People even with the same BCBS have different plans so you can't go by what anyone else tells you. And the person who told you that BCBS (or any insurance for that matter) doesn't do pre-approval is just plain nuts. You practically have to get pre-approval before you fall down steps and break a bone! Call the company and request the newest editiion of the benefits book. You probably have a copy, but if you're like me have no idea where it is! You are being jerked around because this is a very expensive surgery and I can promise you they don't want to pay for it. I had to go through the same thing when I wanted a breast reduction surgery. It clearly stated in my book that reconstructive surgery is covered but not cosmetic. My surgery was a reconstructive one and after a year of fighting and appeals, they finally agreed to pay for it. If you haven't already, begin the supervised weight loss program in the meantime. It could take just as long as it took me and then you will have their requirement met whether it be 6 months or a year of supervised weight loss. Good luck to you and I applaud you for having the courage to do something about your weight. I know its a very scary surgery but I've known lots of people to do it and they come out fine. And skinny!