insurance

Does anyone have blue cross and blue shield of Michigan? If so what documentation did you need from your doctor. All I have been told is that my policy states if my doctor feels the surgery is "medically necessary" HELP! Steph

Good luck. Please check the BC/BS website. There are detailed instructions regarding WLS. Be sure to read the instructions very carefully. Most BC/BS programs immediately answer, "If medically necessary" on the phone. The devil is in the details of your specific policy. The first thing you need to check with your HR person or in your specific policy manual to see if there is an exclusion for WLS. Most of the BC/BS clerks on the phone do not check your specific policy. If you feel that you are getting the same answer ask to speak to an "technologist". They can give more detailed information. Have your insurance card ready to answer all their questions. If there is no exclsuion BC/BS usually request a 5 year documented history of obesity in your medical charts. They also request a 6-12 month supervised diet program (supervised by a physician who is not a surgeon, dietitian, counselor, psychologist, etc). Weigh****chers & Jenny Craig do not count unless your doctor has documented in your medical record that is what you have been doing and they are supervising it. All that is sent with your surgeons Letter of Medical Necessity. A letter alone from your primary care doctor carries no influence. Documentation is everything. Do not trust the person on the phone. Contact your HR person and make sure they have the details of your specific policy. BC/BS of Michigan offers many different policies to tons of people. It all depends if there is an exclsuion to WLS on your plan. Selecting a WLS program now will help you navigate the insurance nightmare. We work with Deaconess in Cincinnati. Good luck

Steph, We've got BCBS of NJ and it's pretty much what Dr. Rodriguez said. 5-yr weight history: they need one office note per each year with your weight along with what the doctor was treating you for or a list of medications you were taking at the time Documented diet history: any office/clinic notes documenting supervised weight-loss trials within the last 2 calendar years. If you don't have that then it's a 6 mon. supervised weight loss program. BCBS of NJ changed their requirements from 3 mon to 6 mon at the end of 2006. Blood tests. Any cardio-pulmonary testing that may have been done recently, including ECG's. And as far as the "medically necessary" that is the same run-around I got on the phone too. Peggy