BCBS of MICHAGIAN PPO

tyrind · 05-15-2008, 10:49 PM

Hellooo Family. I was just wondering who has had an experience with BCBS of Michigian PPO. Are they hard to deal with when it comes to approval??? My bariatric coordinator called me & said she called them for insurance approval for the Lap Band for me & they told her they don't do pre-approval, which that is what they told me also. So the coordinator said that they want her to mail in all of my information ( 6 month weigh-ins, physic evaluation, & PCP office notes supporting my failed weight attempts) to them. So what happens when they receive my information?? I am totally confused!!!

Boxeremma · 05-16-2008, 05:27 AM

I hate BCBS of Michigan. I have good news and bad news.

The bad news....Legally they only have 45-60 business days to make a decision and get back to you. Long story short they took 84 business days to get my decision. They kept telling me and Lap Band Solutions that they do not do pre-approvals and I have coverage for that service. My benefits stat that I have coverage if I meet x...y...z criteria. Lap Band Solutions and was trying to get an approval from BCBS saying I met those criteria. It was a very frustrating process and I called both them and Lap Band Solutions daily. I also went so far as to file a complaint with the Department of Insurance in Michigan.

The good news.....They did approve me. They approved me on April 30th and I had my surgery on May 12th. I am a little sore, but overall doing great. I would do it over again in a heartbeat.

My advise to you is hang in there. It sounds like you are at the beginning of the process, it will be long, but don't give up. Feel free to email me anytime you have questions.

Christina

tyrind · 05-16-2008, 12:04 PM

Quote:

Originally Posted by Boxeremma

I hate BCBS of Michigan. I have good news and bad news.

The bad news....Legally they only have 45-60 business days to make a decision and get back to you. Long story short they took 84 business days to get my decision. They kept telling me and Lap Band Solutions that they do not do pre-approvals and I have coverage for that service. My benefits stat that I have coverage if I meet x...y...z criteria. Lap Band Solutions and was trying to get an approval from BCBS saying I met those criteria. It was a very frustrating process and I called both them and Lap Band Solutions daily. I also went so far as to file a complaint with the Department of Insurance in Michigan.

The good news.....They did approve me. They approved me on April 30th and I had my surgery on May 12th. I am a little sore, but overall doing great. I would do it over again in a heartbeat.

My advise to you is hang in there. It sounds like you are at the beginning of the process, it will be long, but don't give up. Feel free to email me anytime you have questions.

Christina

Thanks for the reply. Actually I am not at the begining of this process I have done all of my tests & 6 month diet & physic evaluation My bariatric coordinator sent off my information on Tuesday I PRAY that my BCBS is different than yours! Even though they both are of michigian, they still could be a little different. Congradulation on your surgery & i hope you are feeling well. Just slide over a little bit cause i am right behind you girlfriend!!!!!!!

Boxeremma · 05-16-2008, 03:57 PM

Come on over, there is plenty of room for you!!!!

I will pray for you daily that you do not have to go throught what I went through. I wouldnt wish that on my worst enemy.

What state do you live in? Do you know what kind of pre-op diet your doctor is going to put you on?

My pre-op diet was awesome. For breakfast I could have a scrambled egg and toast. For Lunch I could have a lean meat and a green vegtable. For an afternoon snack a protien shake, and for dinner a protien shake. The doctor said they didn't care what order I had them in, so I could have breakfast for dinner or dinner for lunch. As long as I was getting in those 4 small meals it did not matter when in the day I had them. It was really great!!!! After day 2, I was fine. I could sit with others that were eating and just drink my shake. Also, I only had to be on it for 1 week. In that week, I lost 14.6 lbs. I was so excited.

Keep me posted on your progress and I will be praying for you.