BC/BS of MI

[AmyinMI 5]

I am new to the forum & very early in my journey. I am going to my initial informational meeting tomorrow night. They sent me an insurance worksheet and when I called BC/BS I gave them my codes & asked the questions. When I asked if I needed pre authorization she said no as long as the Dr can document all of the criteria have been met. Is this normal? Reading everyone's stories on here & just knowing how insurance works makes me a little leary. Does anyone have any input, ideas or experience with this?

Thanks!!

[Paul11011 372]

Howdy neighbor...(maybe)....at least we're both in MI anyway. Insurance coverage can very from policy to policy. If the surgeon that you are working with can provide all the information and documentation that the insurance company requires then you're primary care doctor would not have to be involved at all. I would recommend talking to them about it and letting them know you are pursuing WLS. They will need to know as it relates to your follow up healthcare with them but they may not have to be any part of getting approval. Good luck! Depending on where you're located and if you're looking for a great surgical center let me know and I would be happy to give a recommendation.

[lucy87 5]

I also have bcbs of mi but its a ppo and didnt need any pre authorization ; all they wanted was diet documentation ( 6 months), minimum bmi of 35 with co morbities and a letter from dr saying he recommends it. im "lightweight cause i have less than 100lbs to lose, i havent had my phsych eval nor my diet documentation but did go to consultation and basically they just told me they only needed what ins required. I do know some other insurances may need pre authorization but my bcbs of mi doesnt need anything except the doctor just needs the approval letter from the ins that is ok to proceed with surgery after the requirements are met.

[AmyinMI 5]

Thank you for your responses!!! I will find out more tomorrow. I am in the Lansing area & plan to use Sparrow's Weight Management Center. Who & where do you recommend Paul? Always love to hear positive referrals.

[Paul11011 372]

I went with Grand Health Partners. They are based in Grand Rapids but I know they do work out of other hospitals. I'm not sure if they have made any affiliations with Lansing as of yet. My surgeon was Dr. Baker, one of the founders of the organization. All four of their surgeons are top notch and on the leading edge of WLS surgery innovations. I know of patients they have worked with in DeWitt, Ann Arbor, and Mason. If you're interested their website is www.grandhealthpartners.com