Blue Shield of CA PPO

[Tammy N 1]

Hi, wanted to see if anyone has gone through blue shield of CA PPO process. After years of dieting with little sucess, I am seriously thinking about getting the gastric sleeve done. But I'm afraid I won't qualify...I am right at a 35 BMI. So wanted to connect with other people that have tried to get qualifed with this insurance. Otherwise, I do think my alternative would be to go to Mexico. Thanks!

[Dave In Houston 199]

I'm not familiar with that PPO, but you may qualify at a lower BMI if you have other conditions such as blood pressure, sleep apnea, pre-diabetes, etc.

Good luck.

[River Moon 52]

I have BS of CA PPO and also got the gastric sleeve. If you have a bmi of 40+, then you qualify. If you have a bmi of 35 with at least one comorbidity, then you will qualify too. They require a psychological evaluation, nutritional support, proof that you have attempted to lose weight in the past, particularly within the past 3 - 6 months (primary doctor can provide that information - pretty much just showing weight loss and weight gain again). I also had to do multiple tests, but that was due to my surgeon's requirements, not insurance. My surgeon's office told me that Blue Shield of CA is one of the easier insurances to work with. They don't make you have to jump through as many hoops as other insurances. Once my paperwork was submitted along with all my requirement documentation, I got approved in less than a week.

Here is a link to a pdf on Blue Shield of California's website. It shows the requirements for weight loss surgery, to help give a more thorough idea.

https://www.blueshieldca.com/bsca/bsc/public/common/PortalComponents/provider/StreamDocumentServlet?fileName=PRV_PA_Bariatric_Surgery.pdf

Edited September 12, 2021 by River Moon
Added link

[Tammy N 1]

@River Moon wow! thank you for all of this info!! from your initial consultation how long did it take to book your surgery? i haven't seen my pcp in the last 6 months, just saw him the other day to get his thoughts on the sleeve.

[River Moon 52]

7 hours ago, Tammy N said:

@River Moon wow! thank you for all of this info!! from your initial consultation how long did it take to book your surgery? i haven't seen my pcp in the last 6 months, just saw him the other day to get his thoughts on the sleeve.

You're very welcome! I had my first consultation around late April, and had my surgery July 7th. Once I had the consultation I just went head-on into the process and started scheduling all my appointments and testing dates. My surgeon had me go through a lot of tests like an upper endoscopy, cardiopulmonary stress test, chest xray, and covid test (day before surgery). I already had my gallbladder removed several years ago so I didn't have to have an ultrasound for that. I wish you luck in your journey. You'll do great! It's the best decision I've made for my health.