NEW NEWS I DID TALK WITH A REP. FROM BCBS MI AND THEY HAVE MADE REVISIONS TO BARIATRIC CRITERIA NO LONGER 12 MOS. PCP SUPEVSD. DIET. IT IS NOW 6 MOS. YEA!! wtg BCBS MI!!!:tt1:

And if you have a BMI over 50 you do not need any do not need any medical documentation at all.

ok....i'm confused about bcbs-mi.....my policy is with blue cross blue shield -mi and they are still telling me that is 12 months supervised diet.....i would love to know which policy you have.....or maybe this is so new that even the reps don't know about it?

This is brand new this year. A BMI over 50 you do not need medical documentation. A BMI below that and you need 6 months. It should be standard for all BCBS unless you have a specification in your policy that states it does not cover or it covers with no restrictions.

sent you a private message

Answered =)

I just wanted to thank you for the information on bcbs....It turns out it is true and since my doctor is out of state, only michigan providers were notified. Thanks to the information, I now can possibly have this done in march and not october....thanks again....

Hey no problem. I just want to share the awesome info with everyone else. I just hope that more insurances start following suit and the surgical option becomes more readily avalailable for those who need it.

YOu are so welcome! I called to make sure I had everything in order for my surgery and the rep @ BCBS told me the great news!!

Whoever ask about the # look mon the back of your card because you might have a different dept. to handle your company's ins.:tongue::tt1:

Question. As far as the 6 months BC supervised diet....what if I have done that several times over the years, but dont have proof on paper? I moved, and my records are all over the place. I doubt if I could get anything if thats what they need. Or will they take my and my Dr's word for it in her written report? Or worst case, I could be looking at 6 months supervised diet from now???

That's great news, I'm on my 5th week of waiting for pre-approval from BCBS-MI. I had met all of the criteria but the consecutive 12-month supervised diet. I'm going to call sparrow tomorrow and see if they will schedule me. Thanks for passing it along....

I must let you know, I live in Michigan, but have California Blue Cross. I know they are seperate, but I'm sure have very simular requirements. So far from what I understand, MI BC now only requires 6 mo diet, and CA BC still requires 12 mo. But call and verify. I'm going to too.

O.k. your 6mos. HAS TO BE WITHIN THE LAST 12MOS AND YOU HAVE TO PROVIDE A HISTORY OF THE LAST YEAR. YOU MIGHT WANT TO DBL. CHECK BECAUSE MINE MIGHT BE DIFFERENT.

ALSO I AM CONFUSSED ABOUT "WAITING ON A PREAPPV." BECAUSE THE LADY I SPOKE WITH SAID I DID NOT NEED PREAPPV. BECAUSE IT IS OUTPAT. SUG. SHE SAID AS LONG AS I MET THE CRITERIA I AM APPROVED BECAUSE IT FALLS UNDER MY BENEFITS?! 5 WEEEKS IS A LONG TIME?

Its all so confusing. That puts me at the ins co's mercy! I have my Weight Watchers weigh-in booklet from last year. I went for 8 or 9 months. Maybe they'll be ok with that. When I called my BC (of CA) she said max of 5 days for review/approval, IF they don't ask for anthing more.

I think it is confusing. I met the "letter of the law" in regards to the criteria except for the 12 consecutive month supervised diet. Yes, you're right, they don't "pre-approve" as much as say that I would be covered. If I'd had met the 12-month requirement, I could have scheduled my surgery immediately after meeting the surgeon. I called BCBS today and confirmed the change in criteria then called Sparrow who apologized for "missing" my file in their initial review after the criteria was changed after the first of the year. So, I'm ready to go, just waiting for them to call me with a surgery date. I really appreciate you for passing along the change; I'd still be sitting here waiting for who knows how long? I think it has been most frustrating for me to not be able to advocate for myself. The provider submitted the paperwork so BCBS will only speak to the provider. I have to wait for 3 people to talk to get my surgery date, all of these delays. I'm trying to be patient but it is hard. :frown:

What a pain for you! If only people would DO THEIR JOBS! But at least you got an apology from them, and like you said who knows how long it would have gone on. I can't take credit for the info. I learned it from here too.

OK. Now. I read and re-read the BC "policy" that I printed off their website, and NOWHERE in their criteria does it have any time frame for being on a supervised diet! The 12 month diet requirement thing was in my paperwork from the bariatric surgery seminar I went to back in August. And everyone has been posting about it so I assumed I would have it. My policy shows a review date of 11/07 and effective date of 1/1/08.

But (and a big butt too! lol! ) , just because its not written in the policy, doesn't mean they won't require it of me? Or maybe I'm just being paranoid. Its a good way to kill time until my appointments :frown:

My surgeon appt is next Wed, my dietition appt is next Thurs, my psych appt is Fri of the following week.

Are you talking about the Sparrow Hospital in GR, MI? I'm in N Mich.

I think its no coincidence that we are called "patients" ha ha