Question:
Do the individual Blue Cross plans in Michigan still cover WLS?

I was wondering, do the individual blue cross plans in Michigan still cover the RNY. I have read on here a few times something about policy changes in January regarding preapproval. Just curious.    — Michelle H. (posted on March 22, 2002)

March 22, 2002
I have Traditional Blue Individual Policy. They do cover the surgery, however, they told me that it does need to be pre-authorized with the individual policy. It's not exactly the same as a group policy would be. With the group policy, you don't have the pre existing condition clause. With the individual policy, you do. It states, "If you had a medical conditon for which medical advice, care or treatment was recommended or recieved 180 days before your enrollment date, any services you receive to treat that conditon within the first 180 days after your enrollment date will not be paid by your nongroup coverage. You will be responsible for paying those services". I called BCBS about this, and got two different answers. One lady, after I gave her the surgical and diagnosis codes, went and looked into it. She said as long as I met the criteria, I wouldn't have to wait. Another lady, who didn't take the codes from me, said I would have to wait. BTC said they think it will go through without a wait. Both ladies said that it does need to be pre authorized. They are not getting the money a group policy gives them, therefore, a few more rules seem to apply. As soon as my sleep study results come back, BTC is going to get me a date and try to put it through. IF I have to wait, it will be July when I have the surgery. Could be worse. By the time you get the insurance, your consult, your testing, the six month waiting period flys by anyway. Hope this helps.
   — lerli1