So discouraged

[mommabear2311 31]

I've been waiting and waiting. Here's my story. I have BCBS Michigan . When I called them they said that due to my BMI being over 50 I didn't need preauthorization. The only preauthorization I would need was for my hospital stay and that's a matter of my Dr office submitting a form. I relay this info to the office and they acted like it wasn't true. I've called a few Times over the last month and the office tells me that they haven't heard anything from my insurance . I called today and the lady at the Dr office told me That just a few minutes before she had submitted some more documents that my insurance company has requested. The insurance says they haven't requested anything because it isn't needed. I can't help but feel like I'm being dragged along. Seriously considering switching drs. Am I being impatient ?

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[QueenOfTheTamazons 634]

You could always call another doctor and get a second opinion on how the process works. You could call another doctor and say something along the lines of I have BCBS Michigan and I'm considering gastric sleeve surgery, do you know what is required for insurance approval?

My first doctor was bending over backwards to help me when they thought I was going to be paying $2,500 on top of their surgical fees. But once they found out I was going somewhere else all help stopped. It took months just to get my medical records.

It could be that the doctor doesn't believe in surgery or that they're worried about losing the money for treating The Chronic illnesses that being fat tends to produce.

[cbonet 336]

I called the insurance myself. It took me 2 days and different people. In the end I got a lovely woman who looked into everything and called me back. I was approved and had all the details. I suggest you write down questions before you call, write down the name of the people you speak to and take notes. Good luck.

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[AmiLou 41]

Hang in there! I couldn't go through insurance myself BUT if I could have, I would have been very persistent with my doctor and insurance. I like cbonet's advice. Where is the like button on this?

[QueenOfTheTamazons 634]

I called the insurance myself. It took me 2 days and different people. In the end I got a lovely woman who looked into everything and called me back. I was approved and had all the details. I suggest you write down questions before you call, write down the name of the people you speak to and take notes. Good luck.

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You're lucky you're able to call the insurance yourself. With Anthem Blue Cross the insured can't talk to the authorization Department directly. You have to go through your doctor.

I kept getting denied and the doctor wasn't told anything other than not medically necessary (bull poop) and then did not meet the requirements. They said I did not do the 6 months of medically supervised diet. I knew I had met the goals but had no way to talk to them directly and find out why I was being denied.

Eventually I forced my way through by crying and demanding to talk to a supervisor and not willing to get off the phone until I spoke to a supervisor. In the end I had to get a letter from my primary care who I had done all of my medically supervised diet visits with and I wrote a 3 page letter detailing everything that was wrong with me, my family history of obesity-related diseases and a breakdown of my attempts at dieting over the last 15 years.

I think the process would have been smoother and quicker if there wasn't this barrier between the insurance company and the insured.

[DeletedMember 715]

I have BCBS of Michigan and also had a BMI over 50. I needed no pre authorization at all. I think I got one bill for $20 for anesthesia. Super easy.

My surgeon was well aware of the BCBS requirements. You just have to fulfill certain obligations like clearance from your PCP, a psych visit, etc. Then you are automatically approved.