Blue Shield of California

[SanMateoDave 0]

Hello All, I am a newbie, this would be my first post and I need some advise, please help. I have my consulation this Thurdsay with the surgeon, we'll see what he has to say. I am more worried about my insurance then anything else. I am 35/M, BMI 39, high blood preasure and high triglycerides. Does anyone have any advise? Anyone have any Blue Shield stories? Anything? Thx!

[gordonfamily3 0]

My exp w/ them I haven't had any problems. Quick turn around, friendly to work with. The one pt that I had sounded about like you and he was approved in 2 days. So good luck!!!! The High BP should be enough w/ your BMI of 39.

[sophiekitty 0]

I have Blue Shield HMO and I live in the Los Angeles area. At first my doctor sent in a referral for a surgeon consultation, but it was denied and my doctor said to do a diet/exercise program for 6 mos. I'm 50 and I've been doing diets and exercise programs for all of my adult life so I thought that was bs. I talked to my company's health insurance agent's customer service person and she helped me with getting proof to the medical group my doctor belongs to that I had dieted in the last year or so. I just sent in my Weight Watcher's and Jenny Craig booklets tracking my weight loss. After that, I finally got an authorization for a consultation with a surgeon referred by the medical group. I saw the surgeon on 12/20. He gave me a list of tests I had to complete like blood tests, urine test, Upper GI, chest x-ray, EKG (performed or referred by my primary doctor) and I had to see a psychologist and a nutritionist (referred by the surgeon). During the surgeon consultation, he made it sound like once you get the surgeon consultation authorization, getting approved for the surgery is a foregone conclusion unless something comes up in the tests or with the psych or nutritionist. I completed all of that by the end of January. The surgeon submitted a referral for surgery. I got the authorization pretty fast and now I'm scheduled for surgery on 3/31. Once I got authorization for a surgeon consultation, it's all gone faster than I anticpated. Maybe too fast. I'm really nervous now that I have a surgery date. Good luck.

[Cocoabean 430]

My experience with Blue Shield is very similar to Sophie's. I was denied consultation due to lack of 6 month program. Submitted Weight Watchers booklet and a few other diary entries of other attempts I had and got approval without the 6 month requirement. After that, did the testing and psych thing. Submitted pre-auth mid December, approved mid January, banded mid February.

Denise

[Blund 0]

I also have BCBS of CA (PPO). My paperwork and pre-op test info should be sent in this week. The waiting is awful! My BMI is 36, with sleep apnea, GERD, osteo-arthritis, & depression. They'll be sending in my WW weigh-in card along with my own summary of my weight-loss attempts back to around 1988. I'm really hoping it will go through OK. The bariatric coordinator says BC is about the easiest to get approval from.

[010308 0]

Quick note... Blue Cross Blue Shield has independent licensees which means that coverage will vary by plan. Also, Blue Cross and Blue Shield are two separate entities in the state of California.

It's important to realize that plans may also vary depending on whether you are with a large group or a smaller community group.

It's important that you know what the benefits of your own plan are, and the requirements of your carrier and plan.

[Blund 0]

Thats true. I'm in a small group plan. Check out their website or the phone number on your card. There is a seperate phone number for "pre service reviews" where you can speak to a human. They have been very helpful and nice with me.

My plan states with a BMI under 40, there have to be at least 2 co-morbidities. Some plans also want to see a 6 or 12 month Dr. supervised diet, although its not written anywhere in my plan. I know that doesn't mean they wont ask for it!!

Good luck!