Blue Shield of California has new requirements as of today!

[Trinn 139]

Hi! I'm very new, and this is my first post. In researching for VSG, I discovered the other day that my insurer, Blue Shield (not BCBS) has a new set of requirements starting today. Until today, they required 6 months of nutrition visits etc. Starting today, they appear to be much more flexible. Instead of the list of requirements, they have the following paragraph:

"Patients should have documented failure to respond to conservative measures for weight reduction prior to consideration of bariatric surgery, and these attempts should be reviewed by the practitioner prior to seeking approval for the surgical procedure (e.g., Weight Watchers, Jenny Craig, Optifast, MediFast). The timing, intensity and duration of the preoperative timeframe should be individualized and left to the discretion of the patient and provider. However, given the elective and life changing nature of these procedures, and the necessity of proper education and instruction in the lifestyle changes inherent in both the immediate and long term postoperative management, it is recommended that three months elapse between the initial bariatric consultation and the date of surgery."

So, my question is, has this rolled out elsewhere? How has this affected you? Yesterday was my first meeting with the surgeon. He didn't even talk about time frame, other than saying the nutritionist has to sign off on me. The assistant, however, looked at this new wording (she had never seen it) and said, "Oh, now they require three months." I responded that I didn't think it said three months, that it was flexible with a recommendation of three months, and she said, "No, that's never how it works."

Experiences? It's an issue for me because I'm a student with a long commute, and I will have to do surgery either before the semester starts Sept 8 (with enough time for some recovery), or after the semester ends December 20 or so. I was hoping to get a grant for an overseas language class in January, so this timing affects that -- the grant application has to be in long before a December surgery.

A link to the full revised policy guidelines: https://www.blueshieldca.com/provider/content_assets/documents/download/public/bscpolicy/Bariatric_Surgery_CU.pdf

[Sharon1964 2,530]

The assistant, however, looked at this new wording (she had never seen it) and said, "Oh, now they require three months." I responded that I didn't think it said three months, that it was flexible with a recommendation of three months, and she said, "No, that's never how it works."

I didn't read the whole 55 pages, but it does look flexible to me. I just got my approval, so the new guidelines don't apply to me. If I were you, I would call Blue Shield and ask them specifically.

[Trinn 139]

I'm definitely going to call them; I couldn't today because I was at the dentist for most of the day. :-) Tomorrow I have a round of calls to make, including scheduling my psych eval and upper GI xray.