Walter, please help

[Guest guest]

Walter...I saw you posting so if your reading then please answer me.

I have a BCBS PPO (self funded) policy that states it covers the

surgical treatment of morbid obesity. They denied authorization on

the basis that the particular surgery I want (DS)is considered

experimental in the state of Michigan. However they have covered the

procedure for hundreds of people who submitted it under the code

43846 which describes a bypass of 100 cm or LESS. The have also

covered it for at least one person under the more accurate code of

43847 which covers bypasses over 100 cm. They explained to me that

even though she and I both have BCBS of MI, that she got approval

because she had the surgery in CA and CA recognized that surgery as

acceptable therefore they paid.

1. If Georgia, where I plan to have surgery, recognizes this surgery

as acceptable, then do they have to authorize it for me too?

2. If Georgia doesn't recognize it as non experimental then am I SOL

or do they have to cover it since they have covered it for others

period?

Please help,

Sheila