BCBS of MI PPO? Anyone?

[MandyRN 11]

Hi everyone! So I am just in the begining stages of my journey towards a healthier me but I have a few questions. Now I understand that even though others may have BCBS of MI, plans and requirements along with coverage can differ. With that being said I am just checking to see if any of you fellow BCBS of MI members have ever went through a similar situation. I am 24 years old with a BMI of 52 along with hypothyroidism, pre diabetes, metabolic syndrome, and PCOS. I have already spoke with the insurance company and verified my coverage, and the sleeve along with RNY and lap band are covered if deemed medically necessary. Which with my comorbities I meet that. Also, I was sent a paper from BCBS stating that a 6mo. medically monitored weight loss is required UNLESS your BMI is documented to be over 50. So there we go, I meet that requirement. I have my inital appointment with the bariatric program on the 29th of august along with my psych eval......just wondering if any of you have been through anything similar and if so how long did you have to wait after your inital appointment to have surgery.....I understand that after the 29th they will review my medical information along with the psych eval and determine if there are any further tests I need done prior to submitting to insurance. then after approved I will go for a preop appointment.......I have no problem doing a special eating program for awhile if my suregon requires it but I have tried 8 different diets in the last 10 years..... all of which I have lost weight and been unable to keep it off......sooooo ready to get this tool to assist me in my weight loss journey! I know it will be hard work and a lifetime of change but I am definitely ready for a healthier happier me!

[Fixerupper 335]

I have the same insurance. My bmi was not over fifty but I have found then fast and easy to deal with. Who is your doc?

[MandyRN 11]

I am going to OSU Bariatrics. Not for sure which surgeon either Needleman or Mikami.

[Mrs.FullerRN 189]

I have bcbs of mi and am having surgery at Hurley. My psych eval is 7-30 and then we will submit to insurance. I'll let you know how it goes.

[MandyRN 11]

Awesome! Can't wait to hear how it goes for you! Good luck!

[awifeinmichigan 233]

Hi! Same insurance and BMI over 50. I was approved immediately. However my Surgeon had some kind of surgical procedure himself and was not immediately available to complete my surgery and i did not want to start over with a new Surgeon so I waited. I am scheduled for Aug 2nd. My process began in February.

[MandyRN 11]

Hi! Same insurance and BMI over 50. I was approved immediately. However my Surgeon had some kind of surgical procedure himself and was not immediately available to complete my surgery and i did not want to start over with a new Surgeon so I waited. I am scheduled for Aug 2nd. My process began in February.

Thanks for the reply! Sorry you had to wait! Good luck next week!

[awifeinmichigan 233]

Thanks for the reply! Sorry you had to wait! Good luck next week!

Thanks!

[LindaS 316]

I had the same insurance before they had the 6 month requirement, and I started the process June 27 in 2011, and I had surgery August 9, 2011, so it was a 5.5 week wait for me.

This involved getting a psych eval, sleep study and an endoscopy as well as an appointment with my regular doctor to get a referral letter in during that time.

Good luck to you!

[MandyRN 11]

I had the same insurance before they had the 6 month requirement' date=' and I started the process June 27 in 2011, and I had surgery August 9, 2011, so it was a 5.5 week wait for me.

This involved getting a psych eval, sleep study and an endoscopy as well as an appointment with my regular doctor to get a referral letter in during that time.

Good luck to you![/quote']

Thank you for the response! I am hoping to get it before the end of the year just depends on the surgeon I guess:) excited to get started! How are you doing since the surgery if you don't mind me asking?

[LindaS 316]

I'm doing great. I lost 85 pounds. I haven't had any problems; I am staying active, and I feel very happy about my decision and the results. I work out regularly and eat right most of the time. I feel very normal, which is wonderful.

[Mrs.FullerRN 189]

Hey! Just left the shrink. Called my surgeon and they said bcbs of mi does not do prior authorization so your requirements are verified by the office, you have surgery and then they submit to Insurance. Good luck!

[Nesa 51]

I asked this question in another forum sorry if your reading it again. I finished all the requirements it took me six months. Today I called my doctors office asking for the status on my insurance ( that's sugar we were waiting for it was submitted last week) and they told me I was approved for the hospital stay but it's still pending for the sleeve, for the surgery. This has really freaked me out I'm wondering if there going to deny me now. She said once they know something they will call me back. Im tempted to call Tuesday (haha) to see if they heard anything. I'm so nervous that I'm going to be denied now. Has anyone gone through this? Oh and I BCBS MI.

[Nesa 51]

What* not sugar darn phone =)