BCBSM PPO Sleeve Procedure Approval...

Hello all....

Can you please tell me if you have BCBSM PPO and have had the sleeve procedure coded 43843 and 278.01 approved from Michigan. and also a BMI of under 49.

If you have and had to fight it, could you PM me any letters you sent or documentation you had to send...  I have not been denied, but I want to be prepared for when it happens so I can move this along...

Thank you again!!!  You guys are GREAT!

 Hey Candace,


I don't have an answer, but saw you post. I'm not on this site often and wanted to say hello.
I have heard wonderful things about Dr. Verseman.. Hope all is well with you and hopes that you have some good answers and approval soon..
Amy H

Hi Amy....

Thank you!  I have heard nothing but great things about Dr. Verseman too...  We need to chat and catch up some time soon....

Candy!

Have you called your insurance company (number on the back of your card) and given them the code and asked if it was covered?  That's pretty much the only way to know 100% for sure if it's covered or not. 

Yes, I have done that... and I have been told it's covered as long as I follow all the guidelines---which I am...  but the reason I question it is my doctor's office said they haven't been able to get the sleeve approved unless the patient as BMI over 50 which I don't....  and BCBSM won't give me any documentation, they say it has to come from the doctor----and I'm not very patient, so I was just curious to see if anyone here has had BCBSM PPO cover the sleeve with a BMI under 50......

I've had BCBS PPO and was approved in early January for the Sleeve.  I'm 10 days out from surgery now.  My carrier is MESSA.  I don't know if that makes a difference.  Oh, and my BMI was 42 at the time of request.  Good luck to you.