BCBS of Michigan - How long for approval?

[TheMomHere 0]

I have BCBS of Michigan and all of my things were submitted to them today. Does anyone know how long it will take for approval. I understand that it can sit on the desk at bcbs for up to 45 days if they are backed up with paperwork. But I am curious and anxious. Any input of past experience would be great. Thanks, Patti

[afisher4band 0]

Hello- just wondering what all did you submit to bcbs for approval? I was told by a bcbs mi rep. that they did not do pre-approvals - that they just checked everything to make sure that you meet the criteria for surgery?

[reif78 0]

mine took 6 months i have bcbs in pa

[Tralynn222 17]

I have BCBS of MI. I never actually received an official approval from them. They sent me a letter of what they required and I followed it to T. I then submitted all of my documentation and after waiting for 8 months, received a letter stating that the surgery would be paid for. I gave this to my new surgeon's office and they accepted it as an approval.

BCBS of MI adamantly states that they do not require nor do they give pre-approvals, it's up to your surgeon's office to make sure you have filled all of the requirements. Hope you have better luck than I did.

-Traci

[Frustrated 1]

I have BCBS of Michigan and all of my things were submitted to them today. Does anyone know how long it will take for approval. I understand that it can sit on the desk at bcbs for up to 45 days if they are backed up with paperwork. But I am curious and anxious. Any input of past experience would be great. Thanks, Patti

I have BCBS California. My initial wait when I first submitted was 45 days. I called back and was told I'd been denied because I didn't meet the criteria. I had a BMI of 35.9 and it needed to be 36. :smile: If that wasn't bad enough, my co-morbidities weren't severe enough. I had insulin resistance which is pre-diabetes which normally would have been enough, except that I was only taking one medication for it and I needed to have been taking 2.

In order to qualify without the co-morbidities I would have to get my BMI up to 40. I said "Let me get this straight, in order to get this weight loss surgery I have to gain more weight first?" He replied with "Yes, but there's no way you can gain that much weight." Further proof that I was dealing with an idiot. My weight had already increased since my application and I only needed a further 18 or so pounds to qualify. So I ate, and ate, and ate and reached that goal in 3 weeks.

I went through an appeal process once my weight had gotten to the correct level. My family doctor was very helpful with this and submitted the paperwork showing she'd been keeping an eye on my weight for the past 3+ years and it had increased to the level required by them for approval for surgery. I was to wait another 45 days for them to get back to me. I kept calling and asking if they needed any further data. They told me they'd let me know.

When the 45 days was up I called and asked again and was told I had been denied because I didn't meet the requirements. I told them that I did. The person on the phone checked the records and said that my BMI was too low at 35.9. It dawned on me then that they hadn't taken the new documentation into consideration and failed me on my original records.

I explained that I had called a number of times within that 45 day period and asked if they had the correct paperwork, etc, etc and that they had reviewed my appeal on old data and not even considered the new. Thankfully for me I was now dealing with someone new to the company who wasn't jaded and in a hurry to get me off the phone, she actually dug around. She found my new information and made note of my constant requests (they log each time you call, who you spoke with and why, so remember that) and forwarded the information directly to one of the doctor's that makes the decision. She told me it was meant to take a further 45 days but that she would do what she could to rush it through ASAP for me. She called me back 2 days later to tell me I'd been approved and the letter was in the mail. My surgeon would operate without it.

I started the process this time last year. I had my surgery in July. So as you can see it took me a while and at the time it seemed like a lifetime. Hang in there and absolutely do NOT give up if you're denied the first time around.

Good luck Patti!

[serenity seeker 0]

Hi Patty,

I Also Have Bcbs Of Michigan And Am Wondering What Was The Criteria They Needed Before Approval. I'm Having The Hardest Time Speaking To Anyone By Phone. I'd Like To Get The Procedure In Tennessee In April .they're Telling Me To Contact My Insurance Now. Can You Help Me? Thanks

[Frustrated 1]

Hi Patty,

I Also Have Bcbs Of Michigan And Am Wondering What Was The Criteria They Needed Before Approval. I'm Having The Hardest Time Speaking To Anyone By Phone. I'd Like To Get The Procedure In Tennessee In April .they're Telling Me To Contact My Insurance Now. Can You Help Me? Thanks

Call your insurance company and ask them to direct you online to the requirements for lap band surgery. If you have a surgeon in mind already, you should be able to contact them and tell them who your insurance company is and they'll be able to pull the file themselves and give you a copy. This is what my surgeon's office did for me. I also called the insurance company to make sure it was an up to date version.

What you need to remember is that even if your insurance company covers lap band surgery, the company you're (or the primary on the insurance) with, needs to include obesity treatments in their coverage. Some companies don't include it for cost reasons.

[babygrl1234 6]

BCBS of MI adamantly states that they do not require nor do they give pre-approvals, it's up to your surgeon's office to make sure you have filled all of the requirements. Hope you have better luck than I did.

-Traci

This is correct. You don't actually have to send in any documentation for preapproval but the surgeon's office does have to have it in case they are audited by BCBSM.

[lherstine 0]

DON'T LET ALL THE RED TAPE SCARE YOU OFF!! I HAVE BCBS OF MICHIGAN (COMMUNITY BLUE) AND I DIDN'T HAVE TO ACTUALLY SEND IN ANYTHING TO BE PRE-APPROVED. IS THIS POSSIBLY SOMETHING THAT YOU SURGEON IS MANDATING? I ONLY NEEDED TO FOLLOW THEIR REQUIREMENTS. 1 YEAR OF PROOF FROM MY M.D. THAT I HAD BEEN TRYING TO LOOSE WEIGHT AND FAILED. I HAD TO GET A CARDIAC CLEARANCE, A PSYCHIATRIC CLEARANCE (2 VISITS) AND I HAD TO HAVE A LG LIST OF LAB WORK, AND EKG, AS WELL AS A UPPER GI. MOST SURGEONS HAVE THIS LIST FROM BCBS. IF NOT YOU CAN CALL THE 800 NUMBER ON YOUR CARD AND THEY WILL FAX IT TO YOU!!! KEEP GOING IT IS SO WORTH THE WEIGHT!!! IT TOOK ME 3 MONTHS FROM START TO BAND DATE!!! JUST BE DETERMINED AND LOG EVERYTHING YOU DO AND WHERE YOU HAVE IT DONE! I REQUESTED A COPY OF MY RESULTS FAXED TO ME BY EACH DR. OR HOSP. SO THAT I HAD MY OWN COPY! THEREFORE NOT HAVEING TO WAIT FOR THE DIFFERENT OFFICES TO COMMUNICATE:) BE DETERMINED AND DON'T GIVE UP!!!:tongue:

[babygrl1234 6]

Patti,

Also BCBS of Michigan has changed their requirements this year. If your BMI is over 50 you do not need any medically documented diet attempts. I am not sure if this pertains to you but I thought I would throw it out there.

[TheMomHere 0]

Your surgeans office should give you a list of things that need to be done that are required for your insurance company so that they can get paid. You should get the billing code from the surgeans office for the procedure and for the fills so when you call your insurance they know what they are talking about. Your insurance company should tell you anything you need to know and they may send a packet by mail for you too if you can stand reading all that. Myself I find it easier to talk directly to a person. Good Luck. Patti

PS- Sorry it took so long for my response. if you have any more questions please feel free to ask. If I know I will be more than happy to help you. Patti

[apeters 1]

I have BCBS of MI too and am in my 4th week waiting for approval. I have one slight variance from their stated guidelines on the website (and from a phone conversation with one of their reps) so my information was submitted for pre-approval. I read in an earlier post that BCBS states that they don't "pre-approve" but that's what I'm waiting on and I'm working the paperwork through the doctor's office and BCBS. If I had met all of the criteria, I'd have a surgery date already. I do hope to have one soon!