Question:
Has anyone heard if BCBS Community Blue PPO of Michigan was going to change?

I am hearing some disturbing rumors that all of BCBS will be changing their approval requirements - from 6 months worth of medically supervised diet history to as much as 3 years! I would love for this to be an option for my husband, but he has yet to even start any PCP guided diet, and I know he would not do anything for 3 years. If a doctor writes in your chart or whatever that the patient is obese and they've recommended losing weight, that doesn't count, does it? I'm sure it doesn't. I am dispairing for my DH! Open RNY 03/20/03 326/222/146    — vittycat (posted on December 5, 2003)

December 5, 2003
I do not have the answer for you, but I just wanted to say that I was told the same thing. My BCBS MI was changed recently from traditional to a PPO and that was hard enough, actually costs me more and seems to cover less!? BTC stopped taking my ins. and now for even my RS they are giving me a hard time and my Surgeon said they used to be the easiest to get approval from for weight surgeries. I hope everything goes well for you!
   — Sandy M.

December 5, 2003
Okay, I know this isn't an answer to your particular question. I can however tell you that I went to my plastic surgeon last week for my 3 month follow up (tt, hernia repair, belt lipectomy, breast lift & augmentation) and we were discussing the possibility of BCBS covering my thighs. He told me that they have rejected his last 3 requests for tt coverage (they approved me in late July). So, I know that they are making changes as far as PS is concerned. I would call the company to find out. By the way - congrats on your weight loss!
   — Chloe S.

December 6, 2003
I have Empire Blue Cross and Blue Shield PPO. They have it where you do not have to send a letter, but you have to call and ask for benefit, you send the claim through as if it were a regular routine surgery. The requirements that they have is 1 year of doctor attempted weight loss. Call the medical management line or the customer service line and they will give you the exact requirements....
   — onepowerfullady

December 6, 2003
I have BC/BS of Ca., and when I called them to ask what the requirments are, the rep told me that I just need to meet the surgeons requirements and have my PCP send a letter to my surgeons office for the medical necessity letter from the surgeon. I asked about supervised diets and she didn't come out and no or yes, just restated what she already told me. My surgeons office isn't asking for medically supervised diets either based off of my insurance policy. They gave me a list of what they need for approval, and supervised diets wasn't one of them. I heard they use to though, but they changed it back in August I heard. I also heard that BC/BS won't even be covering WLS anymore starting Jan. 1. But the person that told me this also said that they are always threatening changes, but it never happens. So who knows, I think it's more less if you get lucky at the time you request approval.
   — knkaysmom

December 16, 2003
I have BCBS of MI PPO. The rumor was true, but BCBS decided not to change the requirements for now. The PPO does not currently require any supervised diet restrictions. You only have to have your PCP sign a form of medical necessity. Blue Care network requires 6 months of dr. supervised diet. My hubby has a surgery date of Jan 5 2004. We had no problems with the approval process. When I had mine August 25th 2003, I had my first PCP appt on August on 5th. That is how quick the process can be.
   — [Deactivated Member]