Health Net Blue Gold

[oceangirlpc 68]

I carry this insurance and wondering if anyone has used the same for their surgery. I meet back with my referring dr. on the 28th and was wondering how others liked Health Net Blue Gold. I am on the end of a 6 month waiting period.

[2goldengirl 2,076]

It's a narrow-network product, and I believe it's only offered in northern CA. here in the bay area, which means your two sites for surgery ought to be either Valleycare or Summit in the east bay, UCSF in SF, or Mercy Methodist in Sacramento. The same criteria apply for approval of surgery; here is a link to the policy: https://www.healthnet.com/static/general/unprotected/pdfs/national/policies/BariatricSurgery.pdf

They do NOT require six months waiting period, nor have they since this policy was updated in May 2015, however

"Patient has made a reasonable effort to lose weight and there is documentation that these attempts at dietary control have been ineffective in achieving a medically significant long-term weight loss.". A psychological evaluation is required. Their criteria for individuals with a BMI between 35 and 40 are pretty stringent.

All of these details are on pages 3 and 4 of the policy.

Health Net requires that its delegated medical groups (Brown & Toland, Hill, Mercy, etc.) follow Health Net's criteria. This means that if your medical group says that you need to anything beyond what is mentioned in the criteria, they are incorrect. Your surgeon will have specific requirements for preop diagnostic testing, such as an EGD and/or upper GI X-ray, a sleep study, or an EKG, and that's fine, those are diagnostics your surgeon needs and not subject to the health plan or medical group's policies.

I hope this helps!

[oceangirlpc 68]

wow thank you 2goldengirl you are so informative. I live near Sacramento and my Dr told me he would refer me to the appropriate surgeon after I completed Dignity Healths' requirement which was physical therapy 2 sessions to see if I will be able to workout, nutrician class, completed, doing either weight watchers or myfitness pal, i do track on my fitness pal and to attend a seminar on barriatric surgery which i did at the Methodist location. I have no clue who the surgeon would be although they ususally from the woodland office refer to Dr. Laura Machado but she does not take my plan yet. So, with that all said. I just wonder why I had to go through this whole 6 month ordeal? It started in July and well, I will be meeting back on Jan 28th? i already have sleep anpea and a 40 Bmi, a bad knee so he said I qualified however needed to wait before he referred?