I"M APPROVED.........I think

I got a letter from FUTURE HEALTH who is my company's "utilization review agent" saying that WLS is medically necessary for me. They only say that payment is subject to BCBS benefit limitations and eligibility requirements. Does anyone know if this is my approval, or do I still need an approval letter from BCBS? Ken By the way...I have my EDG on Thursday. I'm a little nervous about that.

Ken, I don't know about your branch of BCBS, but that is what we carry also. We had to just change plans and I am still trying to wade through my new booklet. My coverage is all so very different now even though we are still with BCBS. All I can tell you is ... We received a letter of medical necessity for a surgery my son had to have and yet BCBS refused to pay for it. I called and spoke with them and they told me that yes, their medical board reviewed the case and decided that it was medically necessary that my son get the surgery, but they were not going to pay for it. Still can not figure out why the denial of payment and Still fighting on that payment. But I think this kind of thing is not the norm ... I think that usually if they say it is medically necessary then they will make payment. With my prior plan with BCBS it was spelled out pretty clear in the booklet when it came to WLS. They said over 100lbs - BMI 49? - at least one co-morbidities. So perhaps that is what your letter is telling you that you met their prerequisites? Can you call the docs office or the insurance to find out for sure? I did not any problems getting my approval for my surgery from them. Docs office submitted the paper work and I think it was the next day that they received approval. I did not even know this had happened until the docs office called me and told me I received approval in record time. Go figure ... Best wishes to you. I hope and pray that this is your approval!!! Please be sure to let us know. Hugs, Tammy

Hi Ken, I'm thinking maybe call them and ask is this a yes or a no. I would also call the surgeons office and ask them what they have recieved, they could probably tell you better if this is a firm approval or not. If it is congrats!

I have my fingers crossed..that this is your approval. I suggest you email Marie, she is great about answering her email and she will let you know. Don't be nervous about the EGD...Like everyone else has said..the medication is great...you can't even remember what the Doctor tells you after the procedure...bring someone with you! Its pretty fast...and one step closer to your goal. Hugs, Kimberly

Hi Ken, Good news about your insurance, I am glad things are going well for you. About the EDG no problem, just sit back and enjoy your drugs and plan to rest the rest of the day! Take care Dana

Ken, Great news on the insurance. If in doubt, Marie at Dr. Irgau's office wil be able to tell 100% if you're approved yet. Good luck with the EGD. It wasn't painfull, just a little uncomfortable. Course I had no drugs with my BP so low. Dr. Irgau was very gentle and encouraging. Today my BP is 131 over 65. No BP meds yesterday or today. ((HUGS)) Elissa