insurance BCBS???anyone???

Have you spoken to the insurance gurus?


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Sorry for the late reply.  

I have BCBC of MI PPO.  You must go to a preferred provider at a center of excellence...which means if you want a revision to the DS and want to pay minimal out of pocket and a vetted DS surgeon you will only have the option of Dr. Hares (which only performs them open) or Dr. Kemmeter (which prefers to do the procedure lap).  They both do revisions.  Dr, Hares (last I knew) does not charge a program fee, however Dr. Kemmeter does.  I interviewed both offices to make my decision.  

You will need to get a psych eval by a licensed psychologist in-network and take a test that must be sent out for scoring...Dr. Kelly Johnson? in Belleville, MI is who did mine and she specializes in bariatric patients.  You will need a letter from your primary care doctor stating you are a good candidate for WLS, any co-morbidities, current BMI....and it prob won't hurt to add you have a good understanding of the DS and will be compliant.

Document the name of ANYONE you speak to at BCBS, including the date, and what was said.  Ask them to send you something in writing stating exactly what is covered.

My BCBS policy did not require a pre-op diet.

Be forewarned, unless things have changed you may have a fight on your hands to get the DS. They have a 1 WLS per lifetime rule...at least they did on my policy.  The only way they will cover a revision is if it it life threatening.  When I initially started my WLS journey I had another insurance company and was denied, then when I switched to BCBS they were not covering the DS.  I know that changed about a year ago, but they tried to reserve it for people with a BMI 50+.  My starting BMI was 52, but that went lower because I did a pre-op diet as required by my previous insurance...which later denied me (long story).   

I'm not here very often, so feel free to inbox me if you have further questions.

Good luck!

~Roxy