bellabloom

http://www.bcbs.com/why-bcbs/blue-distinction/blue-distinction-bariatric/bluedistinctionbariatric.pdf

Link to the CME's

Final Post:

To be clear: I have ANTHEM BLUE CROSS THROUGH COVERED CALIFORNIA IN CALIFORNIA!!

every anthem insurance is different. If you have it through a work plan you may have a waiting period, etc. Your requirements could be different. Also don;t confuse this with Blue Shield of California. They are not the same.

Here is how it went for me:

Step One: Called insurance to verify benefits and find out requirements.

40 BMI or 35 with any co-morbid condition

Choose a doctor in their provider list

Go to a CENTER OF MEDICAL EXCELLENCE blue distinction center

Step Two: Found a doctor and hospital combo after lengthy search.

I started with the hospital, by googling the blue centers of distinction list, and I found anthems list online. Then I called the hospital and got the list of surgeons who work out of it. Then I checked the surgeons in my Anthem directory to see who was covered. This took a long time and was frustrating. but I am glad that Anthem is requiring the excellent care that I am getting.

Step Three: I attended a seminar for the nutritionist and a NUT appointment and got weighed in.

I was weighed by my NUT at this time and my weight qualified me with a 40.3 bmi. I was then asked to lose 5% of my weight prior to surgery, which I did.

I was then given a list of my pre-op tests, which were- psych, ekg, blood work, gallbladder and liver ultrasound.

Step Four: Testing

I got right on the tests- this is huge. The pysch appointment took two weeks to come and two weeks for her to submit my report. Don't dawdle on the psych eval- get it scheduled asap because it can take a long time.

Step Five: Checked to make sure all my forms were received.

Once they were, my surgeons office scheduled me to meet with him and to get my surgery date.

Step Five: Met with surgeon and scheduled surgery for 4 weeks away.

I met with my surgeon, he thought I should do a sleeve but I refuse because of heartburn. He is amazing and handsome to boot! They re-weighed me at this time and I had lost weight putting me under 40 bmi, but they only submit the first weight as they had required me to lose weight prior to surgery.

They scheduled me for a surgery date, I was able to choose one sooner but my work schedule prevented it so I scheduled four weeks away.

Step Five: Submit to insurance

My surgeons office submitted my paperwork to the insurance within a couple of days.

Step Six: Insurance Approval

My insurance told me it would take 5 business days to approve my surgery. I called back after one day to check and make sure they had all the paperwork, and they had already approved my surgery and called the doctor to let them know!!

I was approved in 1.5 days!!

My bmi was 40.3

Weight 251 Height 5'6

Insurance: Anthem Individual plan through Covered California (Obamacare), Silver 94

I had NO 3 or 6 month diet requirement.

I had only to tell my surgeon's nutritionist which diets I had tried over my life.

So there you go!!!

If you have the same insurance as me, that's what to expect. Remember to make SURE your hospital is a center of excellence or your surgery won't be approved. Make sure you meet all the requirements and your golden!!

Here is a list of the CME's and also a link to the country-wide ones

CALIFORNIA

Alta Bates Summit Mc Summit Campus Oakland

Alvarado Hospital San Diego

Cedars-Sinai Medical Center Los Angeles

Chapman Medical Center Orange

Clovis Community Hospital Clovis

Delano Regional Medical Center Delano

Desert Regional Medical Center Palm Springs

El Camino Hospital Mountain View

Enloe Medical Center Esplanade Chico

Fountain Valley Regional Hospital Fountain Valley

Good Samaritan Hospital San Jose

Huntington Memorial Hospital Pasadena

Keck Hospital at USC Los Angeles

Marina Del Rey Hospital Marina Del Rey

Memorial Hospital Medical Center Modesto

Mercy San Juan Medical Center Carmichael

Methodist Hospital of Southern California Arcadia

Orange Coast Memorial Medical Center Fountain Valley

Parkview Community Hospital Medical Center Riverside

Pomerado Hospital Poway

Providence Saint Joseph Medical Center Burbank

Santa Barbara Cottage Hospital Santa Barbara

CALIFORNIA (cont’d)

Scripps Green Hospital La Jolla

Scripps Memorial Hospital – La Jolla La Jolla

Scripps Mercy Hospital San Diego

Sharp Memorial Hospital San Diego

Southwest Healthcare Wildomar Wildomar

St. Agnes Medical Center Fresno

St. John’s Regional Medical Center Oxnard

St. Joseph Hospital/Orange Orange

Stanford Medical Center Stanford

Torrance Memorial Medical Center Torrance

Tri City Regional Medical Center Hawaiian Gardens

University of California - Irvine Medical Center Orange

UCSF Medical Center San Francisco

Valley Memorial Hospital Livermore

http://www.bcbs.com/why-bcbs/blue-distinction/blue-distinction-bariatric/bluedistinctionbariatric.pdf

Final Post:

To be clear: I have ANTHEM BLUE CROSS THROUGH COVERED CALIFORNIA IN CALIFORNIA!!

every anthem insurance is different. If you have it through a work plan you may have a waiting period, etc. Your requirements could be different. Also don;t confuse this with Blue Shield of California. They are not the same.

Here is how it went for me:

Step One: Called insurance to verify benefits and find out requirements.

40 BMI or 35 with any co-morbid condition

Choose a doctor in their provider list

Go to a CENTER OF MEDICAL EXCELLENCE blue distinction center

Step Two: Found a doctor and hospital combo after lengthy search.

I started with the hospital, by googling the blue centers of distinction list, and I found anthems list online. Then I called the hospital and got the list of surgeons who work out of it. Then I checked the surgeons in my Anthem directory to see who was covered. This took a long time and was frustrating. but I am glad that Anthem is requiring the excellent care that I am getting.

Step Three: I attended a seminar for the nutritionist and a NUT appointment and got weighed in.

I was weighed by my NUT at this time and my weight qualified me with a 40.3 bmi. I was then asked to lose 5% of my weight prior to surgery, which I did.

I was then given a list of my pre-op tests, which were- psych, ekg, blood work, gallbladder and liver ultrasound.

Step Four: Testing

I got right on the tests- this is huge. The pysch appointment took two weeks to come and two weeks for her to submit my report. Don't dawdle on the psych eval- get it scheduled asap because it can take a long time.

Step Five: Checked to make sure all my forms were received.

Once they were, my surgeons office scheduled me to meet with him and to get my surgery date.

Step Five: Met with surgeon and scheduled surgery for 4 weeks away.

I met with my surgeon, he thought I should do a sleeve but I refuse because of heartburn. He is amazing and handsome to boot! They re-weighed me at this time and I had lost weight putting me under 40 bmi, but they only submit the first weight as they had required me to lose weight prior to surgery.

They scheduled me for a surgery date, I was able to choose one sooner but my work schedule prevented it so I scheduled four weeks away.

Step Five: Submit to insurance

My surgeons office submitted my paperwork to the insurance within a couple of days.

Step Six: Insurance Approval

My insurance told me it would take 5 business days to approve my surgery. I called back after one day to check and make sure they had all the paperwork, and they had already approved my surgery and called the doctor to let them know!!

I was approved in 1.5 days!!

My bmi was 40.3

Weight 251 Height 5'6

Insurance: Anthem Individual plan through Covered California (Obamacare), Silver 94

I had NO 3 or 6 month diet requirement.

I had only to tell my surgeon's nutritionist which diets I had tried over my life.

So there you go!!!

If you have the same insurance as me, that's what to expect. Remember to make SURE your hospital is a center of excellence or your surgery won't be approved. Make sure you meet all the requirements and your golden!!

Mine is December 4! Because I am a worrying I am trying not to worry something will come and cancel it. I need to relax I know!!! I have insurance approval so I know it's a go!!

I'm always afraid to jinx things.

I wish I had a preop diet to do to take my mind off things or feel like I could do something already!! 3 weeks!!

I am so ready for this

Just so everyone knows- there are differences in plans under anthem or bsbc of different states. This thread is discussing anthem of California through covered California / individually purchased plan. It's so confusing because insurances vary so I am trying to give clarification with those of the same plan as I have. I am waiting on approval, should know next week and I will let everyone know my exact process once that is done.

I was hoping some other folks with anthem same as mine would detail their experience here to help others relax.

That's why you have the 3 months. The covered California plans as far as I can tel ( fingers crossed) do not require the diet

Ginmarie do you have work covered insurance or covered Cali

I am now in the approval stage. I will report back on this soon. Hoping that there is no required diet as there wording is hard to understand.

In case anyone has this same issue_ I was honest with both my nut and psych about this problem and about getting treated for it. They saw that I had been treated as a plus and actually felt I was a better candidate for the surgery because I had already been through therapy for food issues.

So it wasn't a problem for me and I would suggest being honest.

My insurance is still in the approval process but I don;t think it will be a problem for them either.

haha it's okay I didn't use my real name on here. Plus I really doubt my insurance is watching my internet posts like 007 or I would never pass the psych clearance!! Seriously. Hahaha my insurance sues me later: sorry but you weren't fat enough!! Needed 7 more pounds of blubber mamn.

Anyway, I gained some weight now because I got over the flu, and I'm almost fat enough anyway. I am big enough that my lumber spine is herniating out and can barely walk, I'd say that qualifies me.

I wonder how many people,gain weight to pass their 40 bmi if they are only a pound shy?

Thank you everyone. This is a great thread as I feel there are a lot of people trying to make this huge decision and getting freaked out by all the negative experiences on the web. If course we all want to hear this is going to help us get healthier, not exchange one set of problems for another.

I am still not sure what I am going to do but I have been surprised at the amount of support I have been getting. Imam going to stay the course and see if my insurance will approve me.

One theme I have seen overwhelmingly in the threads is that this is a lifelong commitment. Those who away from their Vitamin regime or don't follow the rules do end up with complications. I think if I donut I want to be sure I can be 100 percent in and it's a lifestyle I can live with long term.

If anyone else had experienced to relate, please add them here. It's nice to see so much information gathered in one place!

* Anthem Blue Cross of California, Covered California Plan through the individual marketplace. Silver 95 plan.

remember, if you have anthem through your work your requirements may be different.

Share your experience with this insurance and let's help out each other! There is nothing so stressful as the beginning. I was so confused by this insurance process I am doing this to help other's in my situation. Let's help out!

1 what was your doctor and hospital

3 what medical requirements were there?

4 what medical tests were required?

5. Did you have to do a supervised diet?

6 how long for approval?

7 what was good about them?

8 what was bad?

9 what should we know to watch out for if anything.

A week ago I was dead set on this surgery. Now I am having doubts.

I have been reading a lot of patients discussing complications after a few years.

I am chiefly concerned about having a hernia or bowel obstruction.

Also I am concerned about having Iron deficiencies.

I am wondering if this is an issue with how surgeries were performed five or more years ago and these problems have become less common?

I am doing this to feel great not sicker.

Should I back off? Would you change your mind and NOT have the surgery if you could?

Meow many of you would stay the course?

This is the portion of the BCBS plan that details the requirements:

1. The individual must have actively participated in non-surgical methods of weight reduction; these efforts must be fully appraised by the physician requesting authorization for surgery; AND

I called them and they could not find any mention of a 6 month supervised diet. I called my doctors office and they said they do not require it. It still seams unclear to me however.

Can anyone with Anthem BCBS OF CALIFORNIA attest to not having to do a 6 month pre-op diet? Please let us know so that other people are helped by this thread.

It is in their medical booklet that they have to get back to you with either approval or not within (5) days of your paperwork being submitted. If they do not, you can assume something didn't get submitted right.

FYI I have one of the covered california plans!

What I have discovered so far:

First off, I have Anthem of California, not BSBC of California.

They are different!!!

Anthem does not require a 6 month diet, but BCBS of Ca does require it!

Also, I have an individual plan, not a plan through my work. If you do have one through a company, you need to make sure they have not excluded WLS in your plan or added other requirements.

You need a CME (center of medical excellence) or your insurance won't work with them!!!
Make SURE you choose a CME. Some hospitals think they are one, but aren't. You must check with your insurance. You will likely have to travel to one if there isn't one in your area. You can also google it.

Another term for CME is a Blue Distinction Center. You can google a list of them. Just make sure you still check with your insurance.

No supervised diet is required. You have to show proof you have tried diets in the past and failed them but you don't have to lose weight or follow a diet for some period of time.

Yes they cover surgery, but each policy is different so you need to check yours.

If you google surg.0024, you will come up with their requirements and policy regarding weight loss. The agent told me if it's not stated on that policy, it's not a factor in their decision making process.

Finding a doc and Hospital:

I suggest you do two things:

Call their customer service department, and speak to them regarding which hospital to choose and which doctor. They should be able to steer you towards a hospital. What I did was I first found a hospital and made sure it was a CME. Then I wrote down the names of the surgeons who worked with that hospital and called them to find one that took my insurance.

Talk to their pre-certification department. They are the ones who can give your information regarding the requirements for your surgery.

Testing:

So far I know they require a nutritional consult and psych appointment.

* Anthem Blue Cross of California

Share your experience with this insurance and let's help out each other! There is nothing so stressful as the beginning.

1 what was your doctor and hospital

2 do you have Anthem Blue Cross covered thorough a covered California Plan? Or through a work plan?

3 what medical requirements were there?

4 what medical tests were required?

5. Did you have to do a supervised diet?

6 how long for approval?

7 what was good about them?

8 what was bad?

9 what should we know to watch out for if anything.

Thank you ladies! I am pretty sure it will be okay!!!!

Help. I can't find a surgeon who takes my insurances that works for a hospital that also takes my insurance!!! It seems like they have done this on purpose so that we can't use our coverage for bariatric!

I find a great doctor who takes my insurance, only to discover the hospital they do surgery at doesn't! I don't understand and I just want to cry.

Can anyone help?

I have BCBS PPO Covered California. I live on the Central Coast but I am willing to travel if I must.

My first choices are San Luis Obispo, or Fresno, Clovis area.

Thank you!

Help. I can't find a surgeon who takes my insurances that works for a hospital that also takes my insurance!!! It seems like they have done this on purpose so that we can't use our coverage for bariatric!

I find a great doctor who takes my insurance, only to discover the hospital they do surgery at doesn't! I don't understand and I just want to cry.

Can anyone help?

I have BCBS PPO Covered California. I live on the Central Coast but I am willing to travel if I must.

My first choices are San Luis Obispo, or Fresno, Clovis area.

Thank you!

Hello ladies-

I am at the beginning of my journey towards a healthier life. Next week I have my first appointment with my surgeon! Everything looks good for me- my weight qualifies, my insurance covers, my family supports. The only real fear I have at this point is being disqualified for STUPID past behavior.

6 years ago I have a 6 month bought with bulimia. I stopped on my own realizing I was being ridiculous and putting my life at risk. I never had the true urge to throw-up, it was only a desperate try to loose weight, which ultimately failed anyhow.

I wouldn't even be concerned about it except it is in my medical records, as I sought treatment for at "eating disorder" later on. Again, hoping that would help me lose weight! I didn't and now this little fact of my bad decisions is on my permanent records.

I am so terrified the doctor or my insurance will say no way because of this period of my life!! So unfair, I can't even say how awful that would be.

I haven't had even a second of bulimic behavior in the past 6 years. I received intensive counseling on the subject and put it in the past. For being overweight I am actually a pretty responsible eater, I just have major problems with potion control and yummy sugary things.

Have any of your wonderful ladies gotten approved after admitting a past eating disorder to your doctors? Do you ladies think this will disqualify me?

I am really scared it will.

Would love and appreciate your insight!