Super newbie w/ Insurance Questions!

[readyfornewme 6]

Hi all! I've been lurking this site for what seems like ages now, and I decided I'd start my own thread of questions because all this stuff is so nerve wracking!!

So I'm in the really early stages of the process... and I've just signed up for Anthem Blue Cross of CA, my first question is- has anyone tried to apply for the surgery so soon after joining their insurance company? Are there any restrictions on that?

Another question- I've become well acquainted with the Anthem Blue Cross requirements for surgery, and it seems it will be pretty smooth sailing for me except for one thing... I haven't had insurance for all of my adult life (25 yrs old), so I don't have a PCP... will that be a problem for me when trying to get the letter of recommendation for surgery? Is it likely that I might find a doctor who would write me a recommendation letter upon first meeting?

Thank you for any and all feedback on these questions!! As I said I'm supremely anxious about all this and don't want to get my hopes up and then trampled on!!

[shellyd88 463]

Hello I don't know your insurance guidelines but usually if u see a gyno a cardiologist or a pulmonary dr for any reasons if u have an established relationship with a dr they can write it up and be considered by insurance company's for approval several ppl I know have done it that way hope that helps

[Beni 1,484]

I have Blue Cross Blue Shield, Federal Employee Program. They require a two year weight history to qualify. You have to show them you have been at a BMI above 40 or 35 with complications such as high blood pressure, diabetes or sleep apnea, etc. This is to avoid people putting on weight quickly just to qualify for bariatric surgery. Have you gone to any other doctor at all in the past 2 or 3 years where your weight was taken? At my bariatric office, they told me, I only needed 2 weight measures and they requested my GP to fax them one from 2013 and one from 2012. If you have no doctor/hospital weight history go ASAP to a GP to start one. If you don't have complications associated with weight make sure your weight is 256 lbs that day as it would place you at a 40 BMI. It's a $20 copay just go see a GP. It would be an opportunity for you to discuss your weight history (which will be recorded) and get some advice on weight loss surgery.

Good luck

[Kandis SupaStar Hill 39]

Hello,

Congrats on your decision to have surgery, I don't know much about BCBS of CA, because I switched over to Tufts because of a job change. I can tell you that as soon as my insurance kicked in, I went to my PCP and got a referral, and two and a half months later I had the surgery. So I don't think it matters when you seek the surgery, it mostly just depends on the insurance requirements. As Beni stated they may require a two year weight history, but your PCP should have that info.

Best Wishes!

[readyfornewme 6]

Hello I don't know your insurance guidelines but usually if u see a gyno a cardiologist or a pulmonary dr for any reasons if u have an established relationship with a dr they can write it up and be considered by insurance company's for approval several ppl I know have done it that way hope that helps

Thank you!! I don't have any established relationships with any doctors but I'm hoping I can find a doctor and explain my circumstance, show them proof of attempts to lose weight before considering surgery... And hopefully it will work out? Fingers crossed!

[readyfornewme 6]

I have Blue Cross Blue Shield, Federal Employee Program. They require a two year weight history to qualify. You have to show them you have been at a BMI above 40 or 35 with complications such as high blood pressure, diabetes or sleep apnea, etc. This is to avoid people putting on weight quickly just to qualify for bariatric surgery. Have you gone to any other doctor at all in the past 2 or 3 years where your weight was taken? At my bariatric office, they told me, I only needed 2 weight measures and they requested my GP to fax them one from 2013 and one from 2012. If you have no doctor/hospital weight history go ASAP to a GP to start one. If you don't have complications associated with weight make sure your weight is 256 lbs that day as it would place you at a 40 BMI. It's a $20 copay just go see a GP. It would be an opportunity for you to discuss your weight history (which will be recorded) and get some advice on weight loss surgery.

Good luck

Thank you! Yes I think I'm going to make an appt to see a doctor asap. As far as my requirements for anthem blue cross of CA, I found this policy page linked from their page:

http://www.anthem.com/ca/medicalpolicies/policies/mp_pw_a053317.htm

So hopefully I'm not confused and found the right policy because if so, I think the requirements could be met pretty easily!

Thank you for your advice!!

[readyfornewme 6]

Hello,

Congrats on your decision to have surgery, I don't know much about BCBS of CA, because I switched over to Tufts because of a job change. I can tell you that as soon as my insurance kicked in, I went to my PCP and got a referral, and two and a half months later I had the surgery. So I don't think it matters when you seek the surgery, it mostly just depends on the insurance requirements. As Beni stated they may require a two year weight history, but your PCP should have that info.

Best Wishes!

Oh my goodness, you've made my day!! That's so fantastic... God willing, I hope my process will be as quick as yours! Thank you!