I dont know what else to do....any suggestions?

I have been battling with my insurance company (bcbs of michigan) for the past three months. They have been telling me something different each time I call about pre authorization. They tell me its not required, then it is, then it isn't, then it is and now it isn't and that seems to be their final answer. They won't give me ANYTHING in writing. I have asked for my policy which they sent but of course it doesn't have anything in it about bypass surgery or not requiring pre-authorization.  I have called to talk to supervisors, the last one I talked to gave me completely different information than what I had been getting. They wont speak to me about certain things regarding the surgery and says my surgeon has to call. The surgeon calls but doesnt get much either, and we still can't receive anything in writing regarding their qualifications. And now since they are sure pre-auth is not required i can't get an approval letter or even a denial letter so that I can take other actions.   Today the surgeon's office basically said there is nothing else they can do, that I'm on my own and they will not do the surgery without pre-auth. They won't even talk about self pay or other options that they have because i have no denial either.  Today is my birthday and I am in tears. I'm trying to stay strong and fight but I don't know what else to do.

I have BCBS of Florida and I can assure you pre-auth IS needed.  I am sorry you are going through all this.  I am also a Dr. Jawad patient.  I am surprised you are having a hard time.  I was approved immediately.  Pre-auth is needed for hospital stay as well.  I would send a certified letter to them asking for a return signature.  Also call them and go as high up as you can go.   I hate when they do play games.  Hoping you get approval soon!

Thank you NeeNee but apparently every state under BCBS has different criteria and not only that but each policy is different as well. I've talked to people on the Michigan board to see if they've had problems and everybody loves BCBS of Mi over there because they dont require pre-auth and people just have the surgery and bcbs pays for it.  But that doesnt happen here, dr. J's office says that it is against their policy to do a surgery without a preauth. and they won't do it. I called the insurance company today and spoke with a supervisor who told me no one has been calling about my case but me....which is odd because dr. j's office says that they have called. The customer service rep i spoke with before the supervisor said that they will give preauth if the provider requests it in writing....which apparently we have but we have received no response.... i dont know.....i have never fought for something so hard in my life only to continue to hit brick walls.Thanks for the certified letter idea. I will try that.

Ask Dr. Jawad for a copy of the letter they sent requesting the pre-authorization and then make a copy of it and FEDEX it to BCBS.  This way you are sure Jawad's office has done what they have told you they have done -- and you can document that your FEDEX letter was received.  Call the supervisor at BCBS and ask her/him to whose attention the package should be sent .  When things like this happen you have to buckle down and get organized and logical.  Jawad's office says they sent it -- BCBS says they did not receive it.  So by getting a copy of the letter and sending it up yourself you will know where the breakdown is.If your insurance is through an employer, you might also talk to someone in your personnel department about helping you.  Personnel should be able to get you the policy information concerning bariatric surgery and they should also be able to advocate for you.  If your "main" personnel department is in Michigan, you may need to speak with someone there.Red

Ask Dr. Jawad for a copy of the letter they sent requesting the pre-authorization and then make a copy of it and FEDEX it to BCBS.  This way you are sure Jawad's office has done what they have told you they have done -- and you can document that your FEDEX letter was received.  Call the supervisor at BCBS and ask her/him to whose attention the package should be sent .   When things like this happen you have to buckle down and get organized and logical.  Jawad's office says they sent it -- BCBS says they did not receive it.  So by getting a copy of the letter and sending it up yourself you will know where the breakdown is. If your insurance is through an employer, you might also talk to someone in your personnel department about helping you.  Personnel should be able to get you the policy information concerning bariatric surgery and they should also be able to advocate for you.  If your "main" personnel department is in Michigan, you may need to speak with someone there. Red Red

Thanks Red! I will request a copy of the letter on monday. I have to call then to speak with the office manager. Thanks for the idea!

I hope this works out for you.  It sounds as if you have coverage for the surgery so you may have to consider working with a different surgeon if things cannot be worked out with Dr. Jawad's office.  Just do not give up.  Self pay should be a very last resort.  IMHO part of the problem with self pay is that down the road if you have problems your insurance could kick up a fuss about covering it and if you were to have complications -- the cost overruns could amount into the tens of thousands -- or even hundreds of thousands of dollars. Have you considered having your surgery in Michigan where people understand your insurance?  Traveling for surgery while may not an ideal situation -- is certainly doable.  I went to Omaha Nebraska for my surgery.  You may also want to consider writing a letter to the Michigan state insurance commissioner. Red

Yea I have thought about working with another surgeon. I really wanted to deal with Dr. J because he has done the surgery for 2 of my family members and they all trust him. I'm not sure why my situation isn't going as smoothly as theirs did.  Thank you again for your ideas! 

Hang in there.  I know insurance companies can be frustrating, but don't give up.  It will all be worth it in the end.  I will pray that things work out soon for you.

Thank you. I hope and pray there is a light at the end of the tunnel.