BCBS of MI
OK, I have BCBS of MI and they were awesome for all of the other procedures I have had done this year - But they are trying to completely screw up my plastics.
My surgeon is trying to get a predetermination letter out of them, and won't do the procedure unless he gets it. Apparently, they have been screwed by BCBS of MI in the past.
BCBS is saying that they don't do predeterminations and will only do a precert 24-48 hours before the procedure.
So my question is - Has anyone with BCBS of MI had this bull**** and how did you get through or around it?
Right now I am having to be the middleman on a daily basis.
My surgeon is trying to get a predetermination letter out of them, and won't do the procedure unless he gets it. Apparently, they have been screwed by BCBS of MI in the past.
BCBS is saying that they don't do predeterminations and will only do a precert 24-48 hours before the procedure.
So my question is - Has anyone with BCBS of MI had this bull**** and how did you get through or around it?
Right now I am having to be the middleman on a daily basis.
_____________________________________________________________________
160 lbs lost. Surgeons Goal Reached in 33 weeks. My Goal in 37 Weeks.
VSG: 11/2/2011; LBL+Thigh Lift+BL: 10/3/2012; Brach+Mastopexy: 7/22/2013
Unfortunately no words of advice to what you need.
Just know that we all here on the Board are with you in spirit as you find a wat to Fight for what you deserve!
You want Reconstructive Surgety-not Cosmetic so you have to find the right code numbers on your insurance.
A few posts down, Joe had ideas on fighting the system and winning. I do not know his insurance plan but maybe pm him and he can send you his letters to help you win your bsttle in butesucracy...
Mikimi in Israek
Just know that we all here on the Board are with you in spirit as you find a wat to Fight for what you deserve!
You want Reconstructive Surgety-not Cosmetic so you have to find the right code numbers on your insurance.
A few posts down, Joe had ideas on fighting the system and winning. I do not know his insurance plan but maybe pm him and he can send you his letters to help you win your bsttle in butesucracy...
Mikimi in Israek
CalamityJane69
on 8/25/12 1:40 pm
on 8/25/12 1:40 pm
BC/BS MI will absolutely not precert but...if you meet the criteria, you are covered. So, you need a surgeon that has a really good insurance person. Be sure to get the criteria that your particular policy has so "you" know what the exact criteria is.
It is very stressful doing it this way but that is BC for you. They actually have really good coverage compared to others I have seen online...WLS and "about" 100# loss...not 100 but about. That is the criteria...no rashes, pain, etc. As for what types of surgeries are covered, only your personal insurance plan can say.
Also don't be surprised if at first they refuse to pay,...it is a big game to them but in the end they have to pay. I got some EOB's showing it was not covered and had some sleepless nights but also got an EOB that showed the surgeon paid so I knew they couldn't pay one and refuse the other but stressful just the same.
Who are you considering? Dr. DiNick is a very skilledWLS reconstruction surgeon. Some days I like him and other days not but I can't fault his expertise in WLS patients and I am not there to make friends.
It is very stressful doing it this way but that is BC for you. They actually have really good coverage compared to others I have seen online...WLS and "about" 100# loss...not 100 but about. That is the criteria...no rashes, pain, etc. As for what types of surgeries are covered, only your personal insurance plan can say.
Also don't be surprised if at first they refuse to pay,...it is a big game to them but in the end they have to pay. I got some EOB's showing it was not covered and had some sleepless nights but also got an EOB that showed the surgeon paid so I knew they couldn't pay one and refuse the other but stressful just the same.
Who are you considering? Dr. DiNick is a very skilledWLS reconstruction surgeon. Some days I like him and other days not but I can't fault his expertise in WLS patients and I am not there to make friends.
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