Anyone with experience with BCBSM PPO?

[AndreaP 0]

I am in Northern MI and have been waiting for a week to hear back from the surgeons office. I was told by my insurance rep that they don't need to prior if the surgeon says I meet criteria. Surgeon said I met criteria. Now I'm just waiting and wondering why it might be taking this long to hear back. Does anyone have any experience with this type BCBS?

[BenisaMartim4 369]

I have Anthem BCBS PPO Ohio ( I live in MS). We have to have an approval. I've been waiting since Oct.26. The suspence is eating me up. I know I meet all criteria, but we all know how the insurance companies can be. I think I would double check back with them to make sure that they told me right about not having to have an approval. I haven't seen anyone with BCBS that has said that yet. I hope it is right, that is awesome!

[5DogMa 62]

My experience with BCBS has been that what customer service says when you as the customer call in to ask about coverage, and what the department that the doctors office calls and then submits for approval could say two different things. I have been told several times from customer service there is no 6 month waiting period and the doctors office was told I had to have 6 months consecutive visits to get approval. Meeting the physical criteria, BMI,and history o obesity, etc isn't enough. My co-worker who had RNY didn't have to wai,t but that was 2 years ago. I'm setting myself up thinking I might have to appeal. We'll see, the submitted for approval last Friday. Good luck, I hope it goes through fast for you.

[AndreaP 0]

Thank you for the replies. I appreciate hearing what others are experiencing and having to overcome.

I think I was tired and anxious last night. Today I am able to remember 'what will be, will be'. I want the upcoming week to be a reflection of how I want to live the rest of my life. I think I'll spend the day planning menus, shopping list and exercise schedule rather than worrying anymore about the insurance. (May turn out to be easier said than done, lol!)

BenisaMartim4 and 5DogMa....I am hoping for your fast approvals too!