Who do I believe? (BCBS question)

Sean and Sarah: Great advice on getting the policy in writing.  After dwelling on this issue all evening I'd come to the same conclusion.  So I'll call BCBS tomorrow and make the request. Who knows if it'll help anyone else, but I'll keep you posted. Pam

Pam: I was able to get my policy on "Surgical Management of Morbid Obesity" from my BCBS web site.  I checked on yours, but it doesn't seem to be available unless you sign in.  My was in the provider section under medical policies, but yours is restricted.  If you havn't done so already, you might want to sign up and see if you can get a copy of the policy directly from their site. Angela

Where on the BCBS website did you have to go to get "Surgical Management of Morbid Obesity"?  I thought I had been everywhere on their website but I have not seen anything like that.  Thanks for the info.  I am now writing an appeal to BCBSHOI.  Pam Silcox [email protected]

Paul: Thank you for your in depth reply.   I should clarify that I am not - in no way - trying to "get around" or obtain an "exception" to the requirements of my insurance for the pre cert diet.  I also understand the concept of the surgeon's office wanting to cut costs in every possible manner --- I'm a business owner, I know how important that bottom line is. I'm also not saying that the diet requirement is hogwash and shouldn't be adhered to.  And no, I'm not jumping into this surgery and wanting it to happen immediately after my decision was made --- if you want to get technical, I'm 2 years into my research and decision making process. I HAVE done 12 months of a diet and exercise program (technically it's going on 14 months now) and my doctor has been fully involved and made aware of my progress during the quarterly visits to his office.    I'm simply stating that the insurance company is telling me that my current status will fulfill the requirements and that information in conflicting with what the surgeon's office is telling me.   I've searched online at the BCBS-Michigan website in the member areas and the specific policy guidelines are not posted there --- so I'll be making the call to get it in writing today. Pam

Those details were in her original post, you could have saved yourself much energy and time as you would have wanted the doctors office to save if you would have just read things completely before posting. Also, isn't it nice to want to save the doctor's office time and money but no one thinks about saving the patient some time and money when requiring them to see a doctor every month for 6 months when this could be accomplished say by visits every other month? But no because we must do what the insurance companies demand of us, but often make it near impossible for us to find out inadvance exactly what they want us to do...as you pointed out visits must be exactly 30-31 days apart...what BS!!!!