Microsoft Insurence

Has any one here been through the process with Microsoft's Insurance? I can't look up the information myself since I'm the spouse, and I'm just trying to find out what their criteria and pre-op requirements are.  I asked my referred surgeons office for help, but they basically told me it was up to me to find out from the insurance company and they would facilitate as best as they can but really I would need to complete everything though my PCP and then come back to them to even talk with the surgeons assistant.  Frustrating to say the least. Has anyone been through the process with MS insurance that would be able to advise or help me? Thank you, V

 

For Premera Blue Cross through Microsoft the requirements are: BMI of 40 or higher or BMI of 35-40 + 2 or more co-morbidities. I just went through the approval process. It was approved in under 4 days from when my Surgeon submitted the letters/paperwork to the insurance. Dr. Lauters office (in Bellevue) has handle a number of Microsoft insurance cases and the office manager said most fly through just a quickly and easily.

Just BMI of 40 or higher or BMI of 35-40 + 2 or more co-morbidities.? No 3 months of medically supervised dieting, including written food log, weekly meetings with dieticians? Really? Wow. Thank you very much, this helps immensely. V

Correct, no 3-months of supervised dieting, etc. They do say "Failed dietary and lifestyle change programs." tried before doing the surgery, but I think for most people they can document attempts at previous failed attempts (weigh****chers, atkins, etc). good luck. My surgery is scheduled for Aug 7th, and I'm going through all the pre-work now, which too is 100% covered by Microsoft insurance (Upger GI, psych eval, dietician meetings, blood work, etc)

I was on the 20/20 Program that MS offers through the ProClub... it worked as long as I was doing 60+ min of cardio everyday, at least until I hit a plateau and gained everything back (plus some).  So how's that for a failed dietary attempt -- $3k essentially down the drain. Can you confirm that, after meeting above criteria, all your surgeon needed to submit was: 1. PCP letter of recommendation 2. NUT eval & recommendation 3. Psych eval & recommendation 4. Surgeon's letter of medical necessity The policy states "Benefits Advisory Recommended" but I could never get anyone to tell me what other documentation (if any) is required. If I need to produce 5 years of medical records, I'm in big trouble :(

Hmm, he's never been a member of the proclub, as he hates the gym, and instead gets the $7 a month. (Big money right?) Ive never worried since my work has its own onsite gym. Is the pro club program a MS requirement?

My surgeon, Dr. Lauter in Bellevue, handled all the paperwork.  There was no letter of referral from my primary care doctor, and my psych/nutritionist appts were scheduled, but there were not completed by the time the approval came in. Dr. Lauter sent in the letter of medical necessity and 4 days later (including the weekend) I got a call back my surgery was approved. In my case, my BMI is pretty high (312lbs at 5'7, so just under 48 BMI).  That high of a BMI may be a big reason I was approved. The only medical history I provided was the narrative diet history that I filled out as part of the forms I did at his office.  I did go through 20/20, twice!  The first time many years ago that I paid out of pocket, and the second time via the company's support.  In both cases I regained the weight after losing about 70 lbs each time.

Jarrah - 20/20 isn't a requirement, it's just a really good "failure" since it's a physician montiored weight loss that Microsoft recognizes. Thedman - thanks for the info... I'll get on my surgeon to submit for approval right now! I'm just under 48 BMI as well with multiple comorbidities.