Blue Shield CA and the insurance update

[Shanni1269 73]

I know it has been a discussed ALOT about Blue shield CA changing their policy July 31, 2015 to no longer requiring the 6 months weight checks. I had my first apt with the surgeon today and they told me I was WRONG. I had the policy change printed out as well as the pre-auth form and the coordinator didnt even want to look at it.

Now I hate being told I am wrong after I have researched a topic....so now ITS ON!!!

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[lolarose13 147]

Hi, so do they require this or not? I'm currently have Aetna but I changed my benefits to Blue Shield CA starting April 1st. I know they will covered the procedure but I don't know about their other requirements. Do you have a website or document I can look at? Thanks!

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[Shanni1269 73]

I just spoke to probably the most helpful person at Blue Shield and no..it is no longer a requirement. It is up to the discretion of the patient and the provider

[Shanni1269 73]

https://www.blueshieldca.com/provider/content_assets/documents/download/public/bscpolicy/Bariatric_Surgery.pdf

Here is the link of the policy my insurance gave me

[lolarose13 147]

Awesome!!!!! Thanks!

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[littlered12973 5]

Hi there, I too am in California and I have Blue Cross/Shield PPO. I have a surgeon who has been doing this for 20 years. In my office, there is one nurse and one insurance coordinator. It was my experience that my office seems to have the process of insurance approval down pat. I almost feel awkward because my journey has been really fast. I know that is not normal. I would really check around to see what office can help you out. From the date of my first consult to my surgery was a month. I had done the diet and met the requirements. I wish that everyone had the same experience because I know first hand that this is a life saver. Both of my parents have had WLS. Best of luck...remember that you can shop around for the best doctor.

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[kaitlynm 335]

I have BCBS of TX and had my surgery last fall. My Doc's office also told me that I had to do the 6 month diet, but when I called BCBS they told me that they no longer required that. Saved me a lot of time and money to make that call.

[Shanni1269 73]

I have gotten confirmation from my insurance that the 6 months is no longer required, but the Surgery Coordinator will not listen to a word I say or even look at the policy from my insurance that I printed out and brought with me to the appointment. I am not trying to tell her she is wrong, just that she doesn't have the most updated information for MY insurance...she is one of those types that doesn't like to be wrong. Like I couldn't possibly know anything about the subject or done any research on my own behalf...like someone couldn't know more than her about MY insurance. Problem is I rely like this surgeon and don't want to upset her because she has my scheduling in her hands..lol.

Now a rep from my insurance is trying to get ahold of her to confirm and until then I keep doing my pre-op instructions.

I have NUT Tuesday, Psych Thursday and an appointment with my gastro doctor the following Monday (still need to schedule the Endoscopy after that). Then that's it...they wont schedule me to do insurance approval because Coordinator is instant that I need 6 months. I have 2 months and still have the next 4 on the schedule...but I REALLY just want to submit to insurance.

Wish me luck

[2goldengirl 2,076]

I have gotten confirmation from my insurance that the 6 months is no longer required, but the Surgery Coordinator will not listen to a word I say or even look at the policy from my insurance that I printed out and brought with me to the appointment. I am not trying to tell her she is wrong, just that she doesn't have the most updated information for MY insurance...she is one of those types that doesn't like to be wrong. Like I couldn't possibly know anything about the subject or done any research on my own behalf...like someone couldn't know more than her about MY insurance. Problem is I rely like this surgeon and don't want to upset her because she has my scheduling in her hands..lol.

Now a rep from my insurance is trying to get ahold of her to confirm and until then I keep doing my pre-op instructions.

Wish me luck

Ask to speak to the Office Manager. Explain your situation and that you can't get past the Insurance Coordinator. That may help.

[Shanni1269 73]

i tried...waiting to hear back

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[Soon2BHealthyAggie 23]

BSCA PPO = 6 months required

BSCA H M O = no 6 months as of 7/1/15

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[Shanni1269 73]

So the insurance coordinator finally received the right information regarding my insurance but now says they are going to use the recommended 3 months from initial consultation before sending approval anyways. The surgeon said NOTHING about that. He said if my insurance didn't require weight checks I could be ready in a matter of a couple months. I think she is punishing me for knowing more about my own insurance than she did and I was persistent in getting the information to her.

I need to call the office to clarify but I am so angry I am afraid I am going to say something that will just piss her off and she will prolong my process even more. I really like this surgeon but do not know if I can deal with this person.

[Shanni1269 73]

O my insurance called me and they have (at my request) tried to call the coordinator at the surgeons office over 10 time and left messages to get her the updated insurance requirements for Surgery. They said they have NEVER returned their calls. She hasn't returned any of mine either. Today I faxed some of my documents over to her and requested she call me ASAP.

It seems my options are deal with her...

Change surgeons (and offices)...

file a grievance...

What do you all think I should do???

Edited March 23, 2016 by Shanni1269

[kaitlynm 335]

I would talk to the surgeon and tell him about her behavior. It is his office and reputation and he needs to control his staff. If that doesn't work, then switch surgeons.

[littlered12973 5]

That is horrible. ..as if it is not bad enough that you are feeling down about the whole process....you have to deal with this type of crap. So sorry!!

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