my insurance(BCBS of MI) No longer covering WLS after 8/1/04!!!

I was just told by a customer service rep for BCBS (of MI) that he had a memo stating that this group would no longer cover gastric bypass after August 1, 2004. I am SSSSOOOO ANGRY!! I have been in the process of trying to get approved since Dec. '03. All I had left to do when my 1st surgeron closed his doors,due to the doubling of malpractice insurance, was my psych eval. I had that done before my 1st appointment with the new surgeon, when low and behold, they tacked on a 12 month MD supervised diet attempt to the previous set of requirements. My Primary care Dr. wrote a letter asking for approval w/o the 12 mos. based on medical necessity(6/15/04). When I called today, they have no record of an approval or denial( they won't say if they received the request)and he drops this bomb on me that if I don't have the surgery before 8/1/04, it will not be covered. I am so depressed. We have 4 children at home and I just don't have the finances to self pay. We were scraping to try to get the copay for this together, and even if I had an approval letter today, I could never get scheduled before august 1. I just feel like giving up. Can anyone give me a glimmer of hope, or some idea as to what to do now. Can they just stop covering it like that? I am sure they were just stalling me to keep from paying. Sorry for rambling on so long, I am just broken right now. Thanks !! ~Michelle

Can you afford to fight them? Don't let them take your dreams and hopes away. Donna

My hubby and I have been discussing hiring Gary. I've contacted him and downloaded all the forms. I was waiting on a response to my primary care doc's request to approve w/o the 12 medically supervised diet attempt. I will come up with the money to fight it if I have to! Thanks! michelle

Michelle, First, I would suggest contacting your HR Benefit Rep to verify the information you received from BCBS. Secondly, you never really said if your surgeon had applied for prior authorization and you were denied or not. If you were already in the process, and then BCBS changed their requirements, you would be "grandfather in" (for lack of a better term) under the requirements in the original denial letter. I would fight this like your life depends on it...which it does! Fight the good fight! Roberta

When my first surgeon applied for prior authorization, the letter that he received stated that they did not require pre-authorization for this surgery as long as the criteria were met, and I met all except the psych eval. I took this letter and the psych eval to the new surgeon, who applied for preauthorizarion again, and they received the same response, that preauthrization wasn't needed, but that the criteria had to be met, which this time included a 12 month medically supervised diet. So, long story short...I never have gotten an approval OR a denial. I do have copies of the letter sent to my first Dr. and a copy of the "newsletter" response that my new Dr. received. Also, my husbands HR rep...I'll try, but they have never been much help with anything in the past. Thanks for the advice. Michelle