Anyone have BCBS Michigan PPO?

[marnie723 0]

I have to do a 12mth supervised diet(I'm now in mth 8) & am a little worried about having it approved. If I end up self-paying(Mexico?) I will feel I totally wasted this last year when I could have been banded. Anyone had any experience with this? thxs.

[ts505050 1]

I have BCBS PPO Michigan. My surgeon had a form letter for me to give to my PCP stating that I had been actively trying to lose weight for at least 12 months. She signed it, since I had been struggling and she knew I had tried WW, Atkins...etc. I had no problem with insurance covering it. Who is your surgeon?

[marnie723 0]

I am going thru AIGB in Texas but our insurance in BCBS Mich.because my husbands headoffice is there. They faxed back the requirements & it stated, "minimum 12mth supervised diet with monthly weigh-ins & exercise regiment" I think I will call & ask for my own description of the qualifications. I have a feeling it won't get approved because at 12mths they will make me go longer ( with the wording of a 'minimum' of 12 mths) Can I ask what your BMI was & if you had any comorbidities. My BMI is 39.5, can't get much closer to 40. I should have stuck weights in my pockets. ha ha .

[ts505050 1]

I was at 40 (I gained about 10-15 pounds so I would qualify, because I didn't have any comorbidities.) Before you go to Mexico, talk to a surgeon in Michigan. You're better off flying here. Or have your surgeon's office talk to a Michigan Surgeons office. I remember the form letter being very simple, and BCBS does not require that it go through them first. My surgeons office just included it in my file, and we moved forward. You shouldn't have to worry about getting approved after you have waited the year. I didn't even have to do that...I had obviously been trying everything up to that point. I actually think it is a really simple formality with BCBS PPO unless your employer has exceptions, which it doesn't sound like it does. I couldn't hurt to call a michigan surgeon and find out about the form so that your Texas surgeon can have it on file. I've read other people's struggles with getting approved and I had zero. For me it was smooth and easy (at least the insurance part of it.) It could be as simple as consulting with an office that is used to the Michigan Insurance process.

Good luck, let me know if you have any other questions...

[demsvmejm 5]

I have BCBS of Michigan, They covered my surgery with no problems. All I had to pay was my deductable ($100) and my co-pay ($500) I met almost all of this with my pre-surgery testing costs. All they required was a letter from PCP and a BMI of 40. The surgeons office took care of the insurance billing with no problems at all.

[marnie723 0]

Thanks for the info. They also included a list of comorbidities which I don't have(well at least the ones on the list) I have lost 5pds in 8mths(sad!) & that's with working out 3-5times per week on a treadmil for 45-60minutes. What surgeon did you use? I have a pcp appt this week & I feel I need to do more work to get this covered faster. We don't have an exclusion on WLS on our insurance so I can't figure out why the same insurance has a different rule. Hopefully I've overlooked something. I would fly to Michigan in a heartbeat if that's what it took.

[marnie723 0]

To demsvmejm........what surgeon did you use also? Also congrats on your weight loss you must feel fantastic.

[Tralynn222 17]

I have to do a 12mth supervised diet(I'm now in mth 8) & am a little worried about having it approved. If I end up self-paying(Mexico?) I will feel I totally wasted this last year when I could have been banded. Anyone had any experience with this? thxs.

I have BCBS of MI PPO - I've completed all of their requirements but I'm still waiting on a decision. The problem that I'm having is that I live in Florida so I can't get any info when I call customer service. Ugh..it's so frustrating.

As long as you complete their requirements, there's no reason they should deny you.

[demsvmejm 5]

Marnie.....Sorry I'm just replying now .......Dr. Featherstone from Grand Traverse Surgery in Traverse City, MI did my surgery. He just started doing LB last October. Has done RNY for years.

Yes, thanks, I do feel pretty good. I quit smoking to have this surgery and I have not smoked since 12/21/2006 (I smoked for 20+ yrs) I'm also off my high blood pressure medication.

Good Luck with your journey

[babygrl1234 6]

You should be fine. I had minimal, and by minimal I mean barely existing, documentation for the 12 months. From what I hear they are very, very lax.

[csrn 0]

:)Hi everyone. I am just getting started in this process and also have BCBS PPO of MI. I am encouraged by your posts. My BMI is 36, with 2 comorbidities, 12 mo.s documented weight loss program (Jenny Craig), also weight watchers x3, Trim 4 Life, Dexatrim, Slim Fast, Atkins, you name it I've done it. If I need to, I will take a sleep apnea test as according to my husband and children I snore like a roaring train. Also, a strong family history of DM and heart disease. I will continue to check back on this thread often.

Best Wishes,

Chris:)

[Boo Boo Kitty 3]

Hey guys, I am glad I found this thread! I have a friend who wants the band after seeing my success, she has BCBS of Mi. Where does she start? She is concerned the 12 month thing, does it need to be continous?

[babygrl1234 6]

I have Community Blue PPO. For my 12 months all that was required was one visit to the doctor every 3 months (4 visits total in any one year for the past 3 years) Clear as mud? Obviously more would be better but I had no problem being approved with my 4 visits.

[faithmd 14]

I would caution you all that unless all of the different Blue policies above can from the exact same employer, there is no way to know if all the requirements are the same. Each employer can pay for different riders. I have MCare HMO and my requirements were stated almost EXACTLY like the OP's. And yes, that did mean MONTHLY weigh-ins with the doctor, NOT WW or Jenny Craig or LA Weight Loss, etc. Discussions with the Dr. MONTHLY that are documented about what I was doing to lose weight, and in my case, I had a 5% excess weight loss requirement, which I didn't make, so I was denied my first application. The next month I kicked it into gear and was approved.

To the OP, please take your insurance card in hand and call the number on it, get them to email or snail mail or fax you a hard copy of the requirements. Also, most large ins co's have case managers fro things like bariatric surgery, ask if your Blue has them, and then ask to speak with one. They are your point person, your sounding board, and the person who can explain it all. In my case, my ins co did NOT accept a letter, they would ONLY accept copies of my office notes for EACH MONTH of my visits. Please follow up with this ASAP.

I considered going to Mexico, but I called around in my area to see who would accept a band from another surgeon, be it from out of the country or from the next state...and I couldn't find anyone reasonable. Very few will accept another surgeon's band, and there is a premium price to take on your care. It is different in many cases, some charge more per fill, some charge a program fee. Unfortunately, we don't have a Fill Centers USA nearby, that is a great resource for those with a band from Mexico.

I ended up going to Hurley in Flint, after considering Dr. Deol, and the guys at Beaumont.

Hope this helps.

[Gotta Get Down 0]

THis is a great thread. I'm gearing up to go to Mexico, but my company also offers BCBS. I may be able to change... I think I'll see if they know yet what policy they are offering and investigate. I did a supervised diet, but couldn't stick to it, WW and diet pills from my doc. It's gone on for more than a year, but no consistently. I wonder if that would work????