BCBS of MI (Waive6Months)

Ok thanks so much! That's what I thought and exactly what BCBS told me (plus my surgeon's office and my HR girl; I called everyone lol).

hello...I have Blue Care Network (the one right up under BCBS) and it said the same for me..my bmi was over 50 and the 6months of diet documentation was waived indeed.

First of all bcbsm does not do pre approvals for baratric surgery unless you do NOT meet the critera.  It is the responsiblity of your physician to make sure he/she has all the documentation to show you meet the critera.  If you do, then they can go ahead and do the surgery.  When they submit your bill to BCBSM, they submit the documentation to show you have met all the critera.  The documentation is reviewed and if you meet the critera, payment is made. 

Second - for all with BCBSM - check back after the first of April - they are changing the critera - again - with the 6 months,  Information is being sent to providers April 1.  The change goes into effect on April 1.  You will be happy with the change.

At this point, the 6 months is waived for a BMI over 50, 

"At this point, the 6 months is waived for a BMI over 50,"

So are you saying it won't be waived after 4/1 for a BMI 50 or over? Or that the 6 mo requirements will change for those with a BMI of under 50?

Because one has a huge effect on me, the other doesn't at all (since I have the 6 mo. requirement waived right now).

I don't know, the information I received did not specify that.  Information comes out 4/1/09.  That should further clarify that.   I think you will be ok. 

Hi

I was wondering where you saw the information concerning the changes.  I would really like to read that info. because I would really love it if  I could skip that step.  Everything else is ready to go.  That is is the only thing holding me back from getting a surgery date.  Please let me know where I can find this information. 

Thanks
Toni

Okay first and foremost I do not doubt any of your posts at all. I am merely sharing what just happened to me just now. I got a call from the Patient Finance Department of the hospital where my surgery took place. Because I called BCBS of MI and they said they do not do a pre authorization so you are right. However, the hospital called back and because of the amount of money (liability) they do a Pre-Determination meaning they will pre-determine that you look to meet all the criteria. However, I did get a Surgery Date of 05/14/09!! With PreOp Testing 05/13/09. While we are waiting; they just mailed out the packet this morning snail mail to BCBS of MI.

When they do the pre-determination, is anything put into writing that you will be approved or is it just word of mouth?  The no pre auth thing scares me as I have BCBSM too and don't want to be stuck with a huge bill!

chances are BCBSM will send it back to the provider stating they do not do pre-auth's for baraitric surgery along with a copy of the critera. 

The pre-auth process is just something that providers have to do prior to surgery or any item that is on the list. It's just a safe guard to make sure the providers aren't about to preform procedures that totally aren't covered.

I work for the Blues and as long as your paper work is in order and you meet the guidelines you should be fine!!!

GOOD LUCK AND I WISH YOU MANY BLESSINGS!!!!!