anyone with BLUE CROSS OF MASS PPO PLAN have info on how to get approval?

I am having real bad luck with getting an approval through them..I am having to appeal their decision because they are having all these reasons why I cannot continue on to surgery. I have a bmi of 53, whats goin on?

Michelle, Why don't you call directly to Blue Cross and ask them exactly what is needed from your doctor. Folks around here have had only but success with Blue Cross of Mass. Even the surgeon's offices have a comfort level with BC of Mass if the patient meets the criteria. Blue Cross will give you a ticket number for your phone call to reference the call--keep track of it. Joan

Hi Joan- thanks for your reply..I was refused because they want me to go to the dr. for 6mos prior to surgery and have a medically supervised diet plan from my dr then they will approve it. Go figure..If I go there for 6 mos its going to cost them more money out of pocket than they can imagine but hey If thats what they want..Im goin for it!!

Hi Michele, I'm not sure which procedure you're planning on, but.... I have Blue Cross Federal and was advised by a friend, who went thru everything only to be turned down for the lap band, to call before making any plans to get the lap band. Sure enough! I called and was told that BC will pay for RNY but not the lap band on my plan. Makes no sense to me, but.....

Hi, it is nice to see some folks from around Boston. I had my gastric bypass on May 18th at Tufts New England. It went great and I am very happy with my progress. Would like to establish a group of people to chat with. Let me know your names and where you are in the process.

Hi Deborah, Hope this isn't a repeat email, I am having problems emailing today. Please add me to your list for emails. MaryLyn 5-21-03 -167

Hi, which doc are you using? You didn't mention whether you're trying to get approval like this on your own or thru a program. Dr. Lautz' office handled all the paperwork/insurance approval stuff for me, and BCBS approved me within HOURS. I had a bmi of 58 and Dr. Lautz was sure to document all my 'comorbidities'. I think his reputation is good too, and these things can help when people consider your case... Do you have acid reflux, stress incontinence, mental/social issues, etc? All of these count as comorbidities, in addition to the more obvious ones such as high blood pressure, high blood lipids, etc etc. I think blue cross will end up spending much less money on me over the course of the next few years as a result of this surgery. good luck and keep on keepin' on...