criteria for BCBS of MI

I have been having a terrible time with my insurance company. Everytime I call they say something different. Does anyone know the current criteria for BCBS? I have been unable to get this info from BCBS or the HR office. Thank you!

I needed a note from my PCP stated that it was medically nessasary for WLS. They also put in the letter my diet attemps and it needs to be stated they were on a diet for 12 consecutive months. STESS THE WORD CONSECUTIVE! if you dont have that word in your letter you will denied. Make sure you BMI and weight is also on the letter. Hope that helps! Kimberley 3/15/2006

Do you happen to have a copy of the letter from you PCP? Did they tell you ahead of time what your criteria was?

yes I do...I have everything! LOL i called bsbs first to see what they need.... read my profile...that will help a bit email me also if you want [email protected] Kimberley

When I had my surgery two years ago all BC required was to be 100 pounds overweight and a BMI of 40 and above. I also had some documented diet attempts and a list of health problems. I was approved in a day by my office. The criteria may have changed for BC but they should be able to tell you it when you call the customer service. Good luck Tricia

Hi Shonna! I have BCBS Community Blue PPO and they DO NOT do pre approvals. My surgeons office knew exactly what my letter of medical necessity needed to state. I simply told my PCP what the critera it ABSOLUTELY had to include and this is what they wrote for me: TO Whom it MAy Concern: I have been Jennifer E's primary care physician since January 2000. She has suffered with obesity since the age of 14. She has been on several different diets for 12 consecuitive months at a time and she herself stating she has been on a diet her whole adult life. All her attempts have been without long term successful results. She is also under my care for asthma, stress incontinence, back and joint pain. Her current weight is 355, height 66inches and BMI 57.36. I have discussed bariatric surgical procedures and risk involved with her at length. She understands and will comply with post-surgical requirements. I recommend her to undergo bariatric surgical procedure and feel it is medically necessary for her morbid obesity. If you need any further information regarding Jennifer E please contact my office. Sincerely, Steven J. Thibault, M.D. Best of luck to you! Jennifer

WOW Mine was the same! Go read my other post..BCBS Pre-ops! LOL

WOW! That is pretty funny that it is nearly identical....guess these docs have had to do this once or twice!

I wonder if its the same Dr.s Office...

I just re read your letter and if your PCP is Dr Tangalos.....it absolutely is the same office.....small world huh?!