Breesmom813

I found it but only because I typed in "blue shield of California medical policies" Yes, it's clearly stated if you know where to find it, which I did not and nobody helped me to find it. This is the part I feel is misleading and unfair. Anyway, moving on. Hopefully 6 months will go quickly. In the grand scheme of things, not a huge deal but I won't take full responsibility for this error.

Nobody in member services ever told me that. Im on the website right now for the insurance provider as well as 3rd party HR service that coordinates the insurance and nothing about guidelines. Maybe I'm missing it but if its this hard to find, that's sounding very unfair to me. I'm logged into our website and looking at everything related to our exact plan.

Can someone please tell me where I was supposed to find the 6 month requirement. I just looked over my entire summary of plan benefits and coverages of which it only says bariatric surgery is covered but for more info check plan document and policy. Read the entire evidence of coverage/policy and not a word about bariatric surgery. When I called, the info was not given to me. So can someone please tell me how this is my fault and not insurance? How did you all find out?

I was required by the surgeons office to have blood tests, 2 x-rays, an EKG, sleep study, psych Eval, dietician appts and lose 15 lbs, all of which I completed.

We checked our package and read through the entire guidelines and it says nothing about bariatric surgery. Yes, I vented, and with good reason. I do blame insurance companies. They are misleading and do whatever they can to weasel out of actually paying for anything. I lost 15 lbs under a diet set forth by my nutritionist. I say that's more telling than 6 months consecutive. It's arbitrary and trite and bs. Ok now I'm done venting. I have a dietician appt next week and still waiting on pcp appt. Shes very hard to get appts with.

This all just seems like bullshit and bad faith. I called and asked what I needed and if surgery was covered and nowhere did I get any info from bcbs that I needed this. Am I supposed to just guess??? The surgeons office gave me requirements and I met all of them. This just seems ludicrous to me.

I was seeing the nutritionist. The insurance company never told me I had to see a pcp for 6 consecutive months and I called them and asked if I was covered and what was needed

Does anyone have an example of a grievance or appeal letter they used and were then approved?

I'm going to file a grievance, I'm just not sure how lenient they are. It makes me sad that its 6 More months of not having energy to play with my 2 year old daughter the way she deserves to have a parent play with her. I've done WW a few times in my life. I try it all, and fail.

No they never told me and I asked multiple times. They only said I needed approval from the dietician that I was ready! I'm out of town and won't be back until next week when it will be September! . This seems so unfair! So now I won't be able to resubmit until March. I just can't believe this.

Hi All. I started the process in January of getting everything together for gastric sleeve surgery. The surgeons office have me a list of things I needed to do I.e. X-rays, blood tests, psych Eval, EKG, visits with dietician, etc. I was told I needed to see the dietician until she thought I was ready and needed to lose 15 lbs. I saw her in feb, march, had to reschedule April and may and saw her again in June and July at which time she signed me off. Finally 2 weeks ago I had my sleep apnea study complete and all was sent to insurance. I got denied because I didn't have "6 consecutive months of medically supervised weight loss program"!!! NOBODY told me I needed that. I even called my insurance back in January and all they said was it would be coveted if deemed medically necessary by physicians. I'm so upset. If I had known it had to be consecutive of course I would have gone every month! I kept a food diary and everything but had no idea it had to be 6 months. Any advice?? Do you think they will actually make me start over with 6 more months?? My BMI is 46, I have type 2 diabetes, high blood pressure, moderate sleep apnea, and I'm only 32. I am so ready for this surgery and I just keep crying because this seems so unfair. Nobody told me this throughout this whole process Help !