Insurance Question...

S W.
on 12/19/06 6:58 am - MI
Gina, try google'ing: bariatric treatment centers in Alabama, also try Bariatric Surgery in Alabama Weight Loss Surgery Centers of Excellence in Alabama... That might lend a hand to you in your quest for a place in Alabama. Hope this helps Stacey W
Pam T.
on 12/19/06 12:19 pm - Saginaw, MI
Definitely the most reliable thing to do is to call BCBS directly. Have your daughter give her policy number and the customer service rep will be able to tell her the exact criteria for her specific policy. Not all BCBS of Michigan policies are the same - it totally depends on the contract that her employer negotiated with the insurance carrier. For instance. Some people with BCBS of MI have been able to get approved for surgery with a simple letter from their PCP stating they've been dieting for so many years, blah, blah, blah. But my policy specifically spells out that the diet documentation must be in my medical records and include .... a list of about 5 things (behavior modification counseling, nutritionist consultation, exercise therapy, pharmatherapy, etc.). If it's not documented in my medical records by my doctor or an approved weight loss facility, they won't accept anything else. They won't accept my comprehensive list of diet history that I personally compiled with pictures and details of the diet results. If your daughter already knows who she wants for her surgeon, have her call and get a "diagnosis code" and "procedure code" for the surgery and all pre-op tests. That way when she calls BCBS, she can give them those specific codes - so everyone is all speaking the same language. Also make sure that the surgeon of choice is an in-network physician and facility. Or if there's a requirement by the insurance company that the facility has to be a Center of Excellence, etc. Then have your daughter get everything in writing. I had my insurance company mail me a letter that detailed the criteria I have to meet. I have also kept meticulous records of every single conversation I have with anyone concerning my surgery. Insurance, my PCP, my surgeon's office, employer human resource office .... just a Word document that's set up like a journal. I keep the date and time I call somene, the number I called, who I spoke to and all the questions I asked and the answers I was given. This documentation will help if you every have to deal with an appeal process. No amount of begging will get you approved. They don't care how long it's been a problem or how many medical problems you have. If you don't meet their criteria for insurance approval, they'll just deny you. So you have to just play their game until you can get what you want. That's what I'm doing. If you check my profile you'll see that I've had some insurance woes. I'm in the 2nd month of my 12 month diet documentation (again!). So I have come to realize how important the record keeping really is. Good luck! Pam
S W.
on 12/19/06 8:24 pm - MI
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