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BCBSM vs. OSU Medical center



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I am so frustrated.....I need to vent so here it goes....

I started this process in July. Being that my BMI is greater than 50, the 6mo weight loss program was waived. I submitted all of my information at the end of July to my surgeons office- OSU. I went to an informational seminar on August 5th. First appointment with the center on August 31st along with the psych evaluation on August 30th. On September 30th I had an EGD. On October 9th my information was submitted to BCBSM for pre approval for the sleeve surgery. October 9th and 16th I had my dietiatian classes for life after surgery. On Ocotber 29th and three times before that I had contacted BCBSM to verify they had all of my information they needed to preapprove me. Finally on the 29th I was told that I was pre approved for the inpt hospital stay and the procedure itself. Being so exicted I called my surgeons office to notify my insurance case worker. He stated that he hadn't recieved anything and he would contact them. After playing phone tag between him and BCBSM for over 5 hours he finally got ahold of a real person at BCBSM who notified him that I had not been pre approved for the procedure, that they never had a precertification form or paper work for the surgery itself, just the inpatient hospital stay. The lady at BCBSM told him he sent the info to the wrong fax number and gave him another to refax everything to. She then informed him that it would take up to another 30 business days for approval - this all occured on 10/29-10/30. So my information was resubmitted on the 29th of October. I have been in contact with BCBSM several times since and they will not give me any information, other than the fact that it is not them (BCBSM) that requires preapproval for the surgery- it is the physicans office. BCBSM only requires preapproval for the hospital stay. They keep telling me that the providers office will have to contact the provider inquiry line for that information. My insurance worker, who I'm sure is sick of me, will rarely answer my phone calls and rarely return them. I have left multiple messages. It has been well over 30 business days since my information was submitted. I believe if I don't hear from him by tommorow I will be in contact with his office manager....If they don't help me I will be finding a new surgeon. I have invested so much into OSU's program I really don't want to go somewhere else. I feel as though I have been very patient, I have had all my requirements met since the end of september. I love the office and physicans but I have had nothing but a horrible experience with the insurance cordinator.....BCBSM has not very helpful in the communication department either.....I feel as though I have slipped through the cracks. Anyone else have this similar issue and if so what did you do to resolve it?

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    • LeighaTR

      I am new here today... and only two weeks out from my sleeve surgery on the 23rd. I am amazed I have kept my calories down to 467 today so far... that leaves me almost 750 left for dinner and maybe a snack. This is going to be tough for two weeks... but I have to believe I can do it!
      · 0 replies
      1. This update has no replies.
    • Doughgurl

      Hey everyone. I'm new here so I thought I should introduce myself. I am 53y/o and am scheduled for Gastric Bypass on June 25th, 2025. I'm located in San Antonio, Texas. I will be having my surgery in Tiajuana Mexico. I've wanted this for years, but I always had insurance where bariatric procedures were excluded. Finally I am able to afford to pay out of pocket.  I can't wait to get started, and I hope I'm prepared for the initial period of "hell". I know what I have signed up for, but I'm sure the good to come will out way the temporary period of discomfort and feelings of regret. I'd love to find people to talk to who have been through the same procedure or experience before. So I look forward to meeting you all. Hope you have a great week!
      · 0 replies
      1. This update has no replies.
    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. LeighaTR

        I hope your surgery on Wednesday goes well. You will be able to do all sorts of new things as you find your new normal after surgery. I don't know this from experience yet, but I am seeing a lot of positive things from people who have had it done. Best of luck!

    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

      Officially here for a long time, not just a good time💪
      · 0 replies
      1. This update has no replies.
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