Michigan Medicaid

[jacinthapittman 22]

Updates ladies?

[k2389 0]

I have Molina I had to do 12 months of Dr. Supervision at the end if 12 it took 3 days for them to approve me

Sent from my SM-G900P using BariatricPal mobile app

[LadySin 404]

I switched from Molina because of the 12-month requirement to BCBS. I'm 2 months into my 6 months wait.

[Lgcoulter33 1]

Ok so I am also in Michigan and have united healthcare community plan through medicaid. I was told at first that I only needed 6 months of managed weight loss then got a call on October 30th, almost 5 months into the 6 months, saying that I need a year. Which one is correct? Im confused...

[diamondchic94 10]

Ok so I am also in Michigan and have united healthcare community plan through medicaid. I was told at first that I only needed 6 months of managed weight loss then got a call on October 30th, almost 5 months into the 6 months, saying that I need a year. Which one is correct? Im confused...

It’s 12 months according to DMC, you can change your plan in December! Blue cross is only 6 months

[Lgcoulter33 1]

Unfortunately, I can't change until May as that's when my enrollment month was. By that time I'll be almost done with my year.

[Creekimp13 5,838]

I've got BCBS of Michigan. Did my 6 months and all prereqs, and the insurance "navigator" at my bariatric group submitted the request for me. Got my approval letter within a week! Am set to have surgery December 5th. Feeling excited and ready to go:) Having sleeve.

Edited November 26, 2017 by Creekimp13

[diamondchic94 10]

Unfortunately, I can't change until May as that's when my enrollment month was. By that time I'll be almost done with my year.

Oh darn what program are you going through

[diamondchic94 10]

I've got BCBS of Michigan. Did my 6 months and all prereqs, and the insurance "navigator" at my bariatric group submitted the request for me. Got my approval letter within a week! Am set to have surgery December 5th. Feeling excited and ready to go:) Having sleeve.

Congratulations

[Lgcoulter33 1]

3 hours ago, diamondchic94 said:

Oh darn what program are you going through

I track everything on spark people, I'm a member of InShape through my local cmh where I get counseling, and I go to my pcp for monthly weigh ins. I'm going to lake Huron medical center in port huron for my surgery. It's formerly known as st. Joseph mercy port huron.

[Momof3yaytome 0]

Okay I have a question I have blue cross complete of Michigan and I was told they do not have a waiting period but the bariatrics place Insist that since it is through Medicaid it is a 12 month program . So I’m a bit confused

[LadySin 404]

5 hours ago, Momof3yaytome said:

Okay I have a question I have blue cross complete of Michigan and I was told they do not have a waiting period but the bariatrics place Insist that since it is through Medicaid it is a 12 month program . So I’m a bit confused

You are correct. I have receipts for the current medical policy.

Click this link to the BCBSM website, or google bcbsm bariatric surgery medical policy MEDICAL POLICY - BARIATRIC SURGERY (GASTRIC SURGERY FOR MORBID OBESITY)

Once the pdf opens, press Ctrl+F on your keyboard. Type 4/20/21 in the search bar.

“Updated the policy to say 4 years for both BCBSM and BCN as per the JUMP’s recommendation and eliminated the 6 months waiting period statements”

I also called Blue Cross Complete @ 800 228 8554. I spoke with a very helpful rep who informed me that there is no waiting period for Blue Cross Complete (Medicaid) Only documented medical weight loss program within 4 years of surgery request. Doctors determine the length of their weight loss programs.

I’d give them a call and maybe do a three-way with your office manager.

[Momof3yaytome 0]

So the office told me they ran the verification again and it still is showing 12 months so I called insurance they told me that someone is lying and it’s not them , the doc office tells me that obviously they don’t know what they’re talking about and getting their policies mixed up that maybe they are thinking of commercial instead of Medicaid, they asked me if I wanted to do a three way with the insurance and head of billing and lord and behold they told them the same thing they have been telling me so the head of billing she’s like oh so sorry they must have made a mistake blah blah blah
So my thing is HOW and another thing the lady at the office told me when I told her that the insurance was telling me otherwise she’s like no that’s not true No MEDICAID insurance is less then 12 month program ….

[LadySin 404]

I don't know what to tell you friend. I certainly can't go back in time and tell them I need to complete 6 more months, even if I wanted to.

Nor do I know why the agent I spoke with would tell me wrong.

I know for a fact that in 2017 I switched from Molina MEDICAID to Blue Cross Complete MEDICAID because Molina require 12 but BCBSM require only 6. I was too poor for the commercial if either. If anyone cares to follow my posts, I had my surgery in February 2019 and promise I did NOT wait 12 month. I would have. Especially now that I've come to appreciate so much more about myself because of my journey. I didn't have however. If you do, don't worry about it! You'll do wonderfully, and you can only come out stronger having done more prep!

[Momof3yaytome 0]

Yeah I am having my surgery soon they said that they require 6months even the the insurance is saying they do not, my sister thinks the office is just trying to make more money which is fine I’m okay with the 6 months instead of 12 lol