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Health Insurance  (Expert Forum)
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troubel with pre authorization
Answered by
Amir Mostafaie - Health Insurance, Insurance
eHealthInsurance Gold River - CA
This forum is for questions and support regarding health insurance issues such as Medicare, Medicaid, Long-term health insurance, COBRA, insurance portability.

troubel with pre authorization

by Bev51, Apr 23, 2008 11:33PM
I have BCBS of Michigan PPO.  MY husband is retired General Motors, and I am on disability we live in Destin Fl.  I have been going to a physician who does surgical weight loss surgery and after going through the 8 appointments to get me ready to have the lap band surgery and checking with BCBS to make sure this is a covered benefit, my Dr now wants a preauthorization number before he will do the surgery.  I have explained until I am blue in the face that BCBS of Michigan does not require preauthorization for out patient surgery(since this surgery is considered such).  THey still say without  on that they cannot do it. I have provided them with the necessary criteria in order for this service to be paid( 12 months of physician supervised diet, listing type of diet, exercise, and behavior modifications, a letter of medical necessity, a BMI of 40 or above with comorbid conditions including hypertension and arthritis and degenerative disc disease, and a psycological evaluation)  this was all sent in on the 18th of March to the predetermination department.
Since then we have heard nothing...I cannot find a number to call and see what the status is of my predetermination, no one in the customer service department will help me and after numerous calls have ask me not to call again regarding it.  I have talked to the BCBS representative for this area through our local union and no one can seem to help me!  
I am not having this surgery to be skinny and beautiful again, I have to have it  for my health, I am weeks away from a wheelchair at this point.  Does anyone out there have any solutions or suggestions on what else I can do besides wait for BCBS to decide when they want to?  thanks

by Amir Mostafaie, Apr 24, 2008 11:50AM
To: Bev51
Dear Bev51,

It sounds like since you live in Florida, you are calling BCBS of Florida who is not responsible for paying this claim! You need to call the customer service of BCBS of Michigan at the phone number printed on your health insurance membership card to find out how your preauthorization process is coming along.

Sincerely,

Amir Mostafaie
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