No Pre Authorization? Blue Cross PPO

I am pretty sure that this means that I won't know if my surgery has been approved. I feel like I am blindly going through all of the steps not knowing if I can even have the surgery. Does anyone else have this type of insurance?

Hi Dreamy, you have not mentioned what insurance you are talking about.  I do know that Medicare does not pre-auth.

I have Blue Cross PPO

I have blue cross PPO,  I was denied,  because my husbands employer has an exclusion in their policy,  so it will be up to the employer if they have the exclusion.  I will be self pay

Most insurance companies do not Pre-Authorize.  It's up to you to confirm coverage and their requirements.

1.  Make sure WLS is covered.  And if your insurance is through your employer, make sure they do not have a WLS exclusion.

2.  Review your policy - if it covers WLS, it will also specify any requirements they have - it should spell out BMI guidelines, such as BMI of at least 40, or 35 with co-morbidities.  It will specify if you have to be on a six month (or other period) medically supervised diet.

3.  Your surgeon's office will have certain steps you have to go through, but make sure you're meeting your insurer's requirements too.

Generally, once you go through your surgeon's requirements, they will submit your paperwork to your insurer - and that's when they actually approve the surgery.  In my case, my insurer required a 12 month supervised diet - so I made sure my surgeon's office had a letter in their file from my primary care doctor about my diet, and that was included in the packet sent to my insurer.

It seems like a lot to go through - lots of "i"s to dot and "t"s to cross - but it's worth it.  Keep reading here, and also check out the blue bar at the top of the page and maybe read "Resources" - About WLS.

Good luck!

I am covered through the end of this year, and that's it. Anything after is up to me.

When the surgeon submits stuff and they approve surgery, in advance of having surgery, that is what pre-authorization is.  Some insurances don't do that, though.  Medicare doesn't.  My surgeon did not have to submit anything before my surgery.  He just submitted the bill after I'd had surgery.

Please keep us posted. I also have Blue Cross PPO and will be submitting my approvals soon. But I have co-workers who have the same insurance and were approved. You can call Blue Cross and they can tell you, they even tell you what is required to meet the approval. Good luck.

The good thing is that the ladies in my surgeon's office check on that stuff for me, and they work on getting all documentation to the insurance company. They say not to worry, and that they have things covered. I know I am supposed to know on my own about my own insurance policy. I currently have insurance through my stepmom, through her employer. Insurance in Michigan is tough to understand...well most of it is. I am still young and learning things about it all the time.

that's not what it means. 

What it means is that they will not approve it in advance.  If you meet their criteria, you just have surgery and they pay for it.  That's what Medicare does.  It's super easy.

As long as you meet their criteria, you know you can have surgery.