Insurance ( anyone have Blue/cross blue shield of Michiagn)

Hi, I am from Mississippi but have Blue cross of Michigan. Just wondering if you had any troble getting them to pay for surgery?

Sundra~ All policies are different but I can tell you that I have BCBS of Michigan (PPO) and they did pay for my surgery. Their requirements were that I had to be over age 18, have co-morbidities, needed to lose at least 100 pounds, and that I could provide documentation of 12 months of previous weight loss attempts. I called the number on the back of my card whenever I needed to ask questions and I always got answers. I hope this helps you. Sandra

On your 12 months documentation, did you wait 12 months and go to the doctor every month or did you use your primary doctors records? Sundra

Hi Sundra! I have Blue Cross (Community Blue PPO). This is the letter my PCP wrote for my insurance company and my surgery was paid for too! They do no do pre approvals but this was enough. 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. Hope that helps you some. Jennifer 355/286/140

Thank you so much. I wish I had thought about posting here months ago. But being from Mississippi I just did not think about posting in Michiagn. But you both have been a great help. I have my pre-op app. tomorrow but still working on the insurance part. I was just going to cash pay and hope for a repayment from the insurance. Sundra

I have BCBS as well and am just starting this process -- see a surgeon on Thursday and will make inquiries about insurance specifics. Jennifer E -- thank you for sharing your letter -- I've been wondering what all has been in one of those pcp referral letters!

I am glad that it has given you an idea! Between you, and me (and the internet ) I did NOT have 12 months of DOCUMENTED weight loss attempts. This letter is/was acceptable in place of the documentation. The office where I had surgery told me EXACTLY what needed to be included in a letter from my PCP if I didn't have 12 months of documented weight loss attempts. Best of luck to you! Jennifer -69lbs gone FOREVER in 11 weeks