Gary-Your opinion please!

Gary, I recv'd a letter from BCBS of MI.  It states that they recv'd my request for pre-approval for lap band surgery ( I sent it over 7 months ago) and that after reviewing all my supportive documentation, their medical consultant has determined that procedure code 43770 is a benefit of my contract.  Therefore services are payable however, please keep the following facts in mind: (Here is what I don't understand and neither does my surgeon's office) - Under the terms of your plan, payment is made only under the following conditions:   a.  Preauthorization and mandatory second surgical opinion requirements have been met. What exactly does that mean?  That wasn't listed in the original letter of requirements that they sent me.  Do I need to get another surgeon's opinion even after I"ve been through the supevised diet and my PCP highly recommends the surgery for me? Any insight you can give would be very much appreciated. -Traci

It stinks but benefits change all the time. Working from an insurance prospective I've seen people start the whole WLS process in July and by time open enrollment in Jan. rolls around it is now excluded but I would just take that as you ARE approved but they want to see you go to another surgeon and have them agree that it is totally medically necessary for you to have it.  Consider yourself lucky if thats all you have to do!  Look at the bright side..At least you didn't get a letter stating your are denied!