BCBS MI PPO BMI 57.8 and getting hell from customer service?

robyn_fresh
on 5/7/08 1:54 am, edited 5/7/08 2:51 am
RNY on 12/18/12
I have been told by people at obesityhelp.com who have the same insurance as me that in January of 2008 bcbs including MI made a change to weight loss surgery criteria stating that 6 months of supervised weight loss is required, but if your BMI is over 50 then it's waived. I have also heard that BCBS MI doesn't do preapproval, that you go ahead and have it done and then they process it. My surgeon's office sent in a letter in and I got a letter back from Anthem saying that 12 months of supervised weight loss needed to be faxed in. I call customer service and nobody seems to know anything about a change made in January 2008. I ask for a supervisor and I get "We'll put you on a list to be called by a supervisor in 24-48 hours" Why am I being jerked around so much? I know that you're very busy Gary, but I need help. I think I'm beginning to go to depression. I am crying, feel like theres no help. I have a 1 year old baby who is watching me cry and it's upsetting her. Now I feel like I'm being a bad mother. I worked very hard to obtain a degree and get a state phlebotomy certification only to get multip[le interviews and no call back. I know its because of my weight. I am running out of money to support my family along with hope here. I am desperate and willing to do anything, please help me. UPDATE: I have a document from BCN, but on the bottom it states "effective dates 1/1/08 (BCBSM)" and it states in the main portion "

The physician has documented failure of non-surgical management including a structured, professionally supervised (physician or non-physician) weight loss program for a minimum of six consecutive months within the last four years prior to the recommendation for bariatric surgery.  This six month criteria is waived for individuals with a BMI 50."

How can they have a document stating that and still tell me otherwise in my letter?

(deactivated member)
on 5/7/08 4:58 am - NY
I sincerely hope someone will help you over here as your situation is heartbreaking and maddening beyond words. Hang in there, I just know it's going to happen for you!!!
mtelliston
on 5/9/08 8:29 pm - Luxemburg, WI
Hi Robyn, I just found this post after responding to another one of yours.  I work with BC/BS of Mich a lot.  So here goes.  Just in the March Record (publication) from BC/BS of Mich they changed the criteria.  You are correct on the new criteria.  However it does matter which source (employer) is funding your plan.  Some plans do still require prior authorization.  or predetermination in BC Mich words.  If you email me I can respond from work and look up your plan on that list.  Hopefully I would have it.  I also can scan and email you a copy of that page of new criteria to take to your surgeon's office.  Usually I have found most plans go with the general criteria.  But there are a few that have their own.  I am concerned that you are getting a letter of response from Anthem.  That would not happen with a BC/BS of Mich plan.  Only claims would be processed thru Anthem.  I can look up your Blue cross state by the alpha prefix and hopefully clarify what state it is.  Each Blue Cross State has a different criteria.  IF the letter was sent to you before the change in March it would have the old criteria in it.   Contact me for more specifics. Take care and don't lose hope!! Mary
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