BCBS California OFFICIAL everything you need to know thread!

[bellabloom 2,467]

* Anthem Blue Cross of California

Share your experience with this insurance and let's help out each other! There is nothing so stressful as the beginning.

1 what was your doctor and hospital

2 do you have Anthem Blue Cross covered thorough a covered California Plan? Or through a work plan?

3 what medical requirements were there?

4 what medical tests were required?

5. Did you have to do a supervised diet?

6 how long for approval?

7 what was good about them?

8 what was bad?

9 what should we know to watch out for if anything.

Edited October 7, 2014 by bellabloom

[bellabloom 2,467]

What I have discovered so far:

First off, I have Anthem of California, not BSBC of California.

They are different!!!

Anthem does not require a 6 month diet, but BCBS of Ca does require it!

Also, I have an individual plan, not a plan through my work. If you do have one through a company, you need to make sure they have not excluded WLS in your plan or added other requirements.

You need a CME (center of medical excellence) or your insurance won't work with them!!!
Make SURE you choose a CME. Some hospitals think they are one, but aren't. You must check with your insurance. You will likely have to travel to one if there isn't one in your area. You can also google it.

Another term for CME is a Blue Distinction Center. You can google a list of them. Just make sure you still check with your insurance.

No supervised diet is required. You have to show proof you have tried diets in the past and failed them but you don't have to lose weight or follow a diet for some period of time.

Yes they cover surgery, but each policy is different so you need to check yours.

If you google surg.0024, you will come up with their requirements and policy regarding weight loss. The agent told me if it's not stated on that policy, it's not a factor in their decision making process.

Finding a doc and Hospital:

I suggest you do two things:

Call their customer service department, and speak to them regarding which hospital to choose and which doctor. They should be able to steer you towards a hospital. What I did was I first found a hospital and made sure it was a CME. Then I wrote down the names of the surgeons who worked with that hospital and called them to find one that took my insurance.

Talk to their pre-certification department. They are the ones who can give your information regarding the requirements for your surgery.

Testing:

So far I know they require a nutritional consult and psych appointment.

Edited October 7, 2014 by bellabloom

[Roz4103 0]

I am with BCBS Anthem of California,,,, and Bellabloom is correct.... I am going with BluePoint which is one of their blue distinction centers.....

[bellabloom 2,467]

It is in their medical booklet that they have to get back to you with either approval or not within (5) days of your paperwork being submitted. If they do not, you can assume something didn't get submitted right.

FYI I have one of the covered california plans!

Edited October 7, 2014 by bellabloom

[bellabloom 2,467]

This is the portion of the BCBS plan that details the requirements:

1. The individual must have actively participated in non-surgical methods of weight reduction; these efforts must be fully appraised by the physician requesting authorization for surgery; AND

I called them and they could not find any mention of a 6 month supervised diet. I called my doctors office and they said they do not require it. It still seams unclear to me however.

Can anyone with Anthem BCBS OF CALIFORNIA attest to not having to do a 6 month pre-op diet? Please let us know so that other people are helped by this thread.

[bellabloom 2,467]

I am now in the approval stage. I will report back on this soon. Hoping that there is no required diet as there wording is hard to understand.

[ginimarie1974 106]

My Dr office told me anthem requires 3 months supervised medical weight loss and that they wouldn't accept weight watchers I was informed I had to go to 1 appt per month approximately 30 days apart. I have completed all requirements including psychological evaluation and appointment with the nutritionist and meet with surgeon on 11/24 and they will submit for approval

[bellabloom 2,467]

Ginmarie do you have work covered insurance or covered Cali

[ginimarie1974 106]

Work covered

[bellabloom 2,467]

That's why you have the 3 months. The covered California plans as far as I can tel ( fingers crossed) do not require the diet

[bellabloom 2,467]

Just so everyone knows- there are differences in plans under anthem or bsbc of different states. This thread is discussing anthem of California through covered California / individually purchased plan. It's so confusing because insurances vary so I am trying to give clarification with those of the same plan as I have. I am waiting on approval, should know next week and I will let everyone know my exact process once that is done.

I was hoping some other folks with anthem same as mine would detail their experience here to help others relax.

[bellabloom 2,467]

Final Post:

To be clear: I have ANTHEM BLUE CROSS THROUGH COVERED CALIFORNIA IN CALIFORNIA!!

every anthem insurance is different. If you have it through a work plan you may have a waiting period, etc. Your requirements could be different. Also don;t confuse this with Blue Shield of California. They are not the same.

Here is how it went for me:

Step One: Called insurance to verify benefits and find out requirements.

40 BMI or 35 with any co-morbid condition

Choose a doctor in their provider list

Go to a CENTER OF MEDICAL EXCELLENCE blue distinction center

Step Two: Found a doctor and hospital combo after lengthy search.

I started with the hospital, by googling the blue centers of distinction list, and I found anthems list online. Then I called the hospital and got the list of surgeons who work out of it. Then I checked the surgeons in my Anthem directory to see who was covered. This took a long time and was frustrating. but I am glad that Anthem is requiring the excellent care that I am getting.

Step Three: I attended a seminar for the nutritionist and a NUT appointment and got weighed in.

I was weighed by my NUT at this time and my weight qualified me with a 40.3 bmi. I was then asked to lose 5% of my weight prior to surgery, which I did.

I was then given a list of my pre-op tests, which were- psych, ekg, blood work, gallbladder and liver ultrasound.

Step Four: Testing

I got right on the tests- this is huge. The pysch appointment took two weeks to come and two weeks for her to submit my report. Don't dawdle on the psych eval- get it scheduled asap because it can take a long time.

Step Five: Checked to make sure all my forms were received.

Once they were, my surgeons office scheduled me to meet with him and to get my surgery date.

Step Five: Met with surgeon and scheduled surgery for 4 weeks away.

I met with my surgeon, he thought I should do a sleeve but I refuse because of heartburn. He is amazing and handsome to boot! They re-weighed me at this time and I had lost weight putting me under 40 bmi, but they only submit the first weight as they had required me to lose weight prior to surgery.

They scheduled me for a surgery date, I was able to choose one sooner but my work schedule prevented it so I scheduled four weeks away.

Step Five: Submit to insurance

My surgeons office submitted my paperwork to the insurance within a couple of days.

Step Six: Insurance Approval

My insurance told me it would take 5 business days to approve my surgery. I called back after one day to check and make sure they had all the paperwork, and they had already approved my surgery and called the doctor to let them know!!

I was approved in 1.5 days!!

My bmi was 40.3

Weight 251 Height 5'6

Insurance: Anthem Individual plan through Covered California (Obamacare), Silver 94

I had NO 3 or 6 month diet requirement.

I had only to tell my surgeon's nutritionist which diets I had tried over my life.

So there you go!!!

If you have the same insurance as me, that's what to expect. Remember to make SURE your hospital is a center of excellence or your surgery won't be approved. Make sure you meet all the requirements and your golden!!

[bellabloom 2,467]

Here is a list of the CME's and also a link to the country-wide ones

CALIFORNIA

Alta Bates Summit Mc Summit Campus Oakland

Alvarado Hospital San Diego

Cedars-Sinai Medical Center Los Angeles

Chapman Medical Center Orange

Clovis Community Hospital Clovis

Delano Regional Medical Center Delano

Desert Regional Medical Center Palm Springs

El Camino Hospital Mountain View

Enloe Medical Center Esplanade Chico

Fountain Valley Regional Hospital Fountain Valley

Good Samaritan Hospital San Jose

Huntington Memorial Hospital Pasadena

Keck Hospital at USC Los Angeles

Marina Del Rey Hospital Marina Del Rey

Memorial Hospital Medical Center Modesto

Mercy San Juan Medical Center Carmichael

Methodist Hospital of Southern California Arcadia

Orange Coast Memorial Medical Center Fountain Valley

Parkview Community Hospital Medical Center Riverside

Pomerado Hospital Poway

Providence Saint Joseph Medical Center Burbank

Santa Barbara Cottage Hospital Santa Barbara

CALIFORNIA (cont’d)

Scripps Green Hospital La Jolla

Scripps Memorial Hospital – La Jolla La Jolla

Scripps Mercy Hospital San Diego

Sharp Memorial Hospital San Diego

Southwest Healthcare Wildomar Wildomar

St. Agnes Medical Center Fresno

St. John’s Regional Medical Center Oxnard

St. Joseph Hospital/Orange Orange

Stanford Medical Center Stanford

Torrance Memorial Medical Center Torrance

Tri City Regional Medical Center Hawaiian Gardens

University of California - Irvine Medical Center Orange

UCSF Medical Center San Francisco

Valley Memorial Hospital Livermore

http://www.bcbs.com/why-bcbs/blue-distinction/blue-distinction-bariatric/bluedistinctionbariatric.pdf

[MissAKY 32]

1 what was your doctor and hospital
Dr. Beeman Kahlil - Palo Alto Medical Foundation (PAMF), a Sutter Medical Affiliate

El Camino Hosptial, Mountain View, CA (3.2 mi from my house!)

2 do you have Anthem Blue Cross covered thorough a covered California Plan? Or through a work plan?
I have Anthem Blue Cross through my job at a start up software company

3 what medical requirements were there?
I am required to explain in depth that I have tried to diet for at least 6 months. My doctor was EXTREMELY thorough in my consultation appointment, where we talked about my diet attempts.

BMI 40 or 35 with health issue

Pre and Post Op Nutrition - no 3 or 6 month requirement

Psych Eval

4 what medical tests were required?
Usual blood work - CBC, thyroid, liver, Hep B, and a few others. There was only one that was fasting (CBC). I was happy to know that I didn't have to do a fasting glucose test. (Your doctor will probably recommend that you begin taking a Multi Vitamin, D3, B12 and Iron - if they don't, you should see another doctor)

EKG - super simple, literally takes more time to undress and put a gown on (makes sure your heart is healthy enough for surgery)

Chest X-ray - to make sure your lungs are clear and healthy (helps the anesthesiologist)

Upper GI with Barium - this is to see the shape of your esophagus, stomach, and small intestine (This sh*t is NASTY. The smell is pleasant, but the taste is REALLY thick and chalky. Other than that, simple.)

5. Did you have to do a supervised diet?

No. Not official. My doctor prefers you start weaning yourself of bad foods - sugar, carbonated beverages, caffeine, alcohol, fried foods, etc. I don't consume most of the before mentioned. I started drinking 3 shakes a day and one small meal (Protein, veggie, whole grain).

6 how long for approval?
Not - sure (will report back after July 8, 2015)

7 what was good about them?
n/a

8 what was bad?
n/a

9 what should we know to watch out for if anything.

Come prepared and educated. You are YOUR OWN BEST ADVOCATE.

[sarahbee 46]

I had the same experience, more or less, as bellaboom. I live in Texas, but my employer is based in Cali, so I have BCBS Anthem. When I started researching, I saw the BCBS requirement for 6mo diet, and assumed I'd have to do it, but after submitted everything, I was approved in 2 days.

The requirements for the surgeon's office to submit the approval were Nutrition and Exercise Physiology classes, Psych Eval, and letter from doctor recommending surgery and noting any weightloss attempts prior (supervised by them, or on your own). It was a much smoother process than I'd expected. And since I was aware of the CME requirement, I had already done the seminar and found a dr. through St. David's medical, which is a BCBS center of distinction.

One thing to note, after I got word of approval from the surgeon, I got the letter from the insurance indicating certificate of medical necessity for my surgery, however the verbiage at the bottom of the letter said "The facility where you are having your surgery is not a CME, and therefore your procedure may not be covered". I called them, and they said they are having an issue with the wrong language being sent out on letters, so if that happens to you, don't freak out!