Sharon1964

I would check again, that definitely doesn't sound right. What that amounts to is a 5-year pre-existing condition waiting period, which is not legal in any circumstance that I can think of.

Blue Shield of California is owned by California Physicians Services (the 1099 we get from them at the end of the year says "California Physicians Services dba Blue Shield of California"). It was originally created by the California Medical Association. Empire Blue Cross Blue Shield is still owned by Wellpoint, I think. In any case, two entirely different companies who share a name and usually have a reciprocal agreement to use each other's panels of doctors.

I'd have a little more respect if they were just honest about it. "I ate (whatever) and I feel bad, please help me feel better about it." Not that I would, of course.

My surgeon says no bread or crackers for the first six months. Since all of our answers are different, what does YOUR surgeon say?

Well, my insurance, Blue Shield of California, dropped their six month requirement as of July 1, 2015. I already "did my time" and had my approval before the end of June. My surgery is in August because my surgeon is booked that far out. And he's doing mine on a Saturday.

Grilled cheese? My surgeon says no bread, crackers or Pasta for six months after surgery. His nutritionist says it forms a gummy paste in your tummy which isn't good for it.

I had to have six months of "a supervised weight loss program with monthly visits". I did the visits with my primary care doctor. Weight loss was not required; just documentation that we discussed eating, exercise, etc.

I love coming here and reading these! Keep up the good work, everybody!

Because those things are not surgery, they are office visits, radiology, etc. Pretty much everything I had done before I was approved could be done for someone not having surgery. I had: Surgical consultation nutritional counseling psych evaluation upper and lower endoscopy colonoscopy pap smear lab work

If you're doing it to get a quicker surgery date, I would call your surgeon's office and ask if it matters. It wouldn't matter at all with my surgeon. He doesn't require weight loss before surgery - he says if you could do it on your own you wouldn't need him. I had to meet insurance and surgeon requirements and then I was approved. They gave me the next available spot, which is in August.

I am a big person with a big personality. I think most people would be afraid to say anything about "easy way out" to me. I'm actually waiting for that day, so I can make my lower lip tremble, produce a small tear brimming on my eye, and say, very quietly, "why would you say something so hurtful and mean?"

I didn't read the whole 55 pages, but it does look flexible to me. I just got my approval, so the new guidelines don't apply to me. If I were you, I would call Blue Shield and ask them specifically.

Can I 'like' this about a hundred times??

How very exciting! Sorry, no advice. Just... YAY FOR YOU!

What does your surgeon and your nutritionist say?

It's up to your surgeon. If you want to do the liquid diet, it won't hurt you.

This doesn't mean what I think you think it means. (say that three times fast!) It doesn't mean your surgeon has to approve you. It means your surgeon has to send in a pre-auth request with the documentation of medical necessity for the surgeon, and then your insurance company evaluates the request and approves or denies.

@@xxjosettexx So did you have your surgery three days ago? How are you doing?

You're going to find huge variations. My first step was meeting my surgeon and discussing which procedure was best for me. Then six months of nutrition visits and a psych eval (insurance requirements). My surgeon required a bunch of other tests, which I did over that same six months. Once my six months of nutrition visits was over, my surgery coordinator faxed my paperwork in to my insurance. I had an approval less than a week later, I think. I called the surgeon's office the next day and the coordinator set the date for my surgery. I will see my surgeon again a couple of days before surgery for a pre-op. My surgeon is booked pretty far out. I'm set for Saturday, August 8. I see a lot of other people not have to wait as long once they have approval. And some offices set a date without an insurance approval, gambling that they will get it before the surgery date (and rescheduling if it doesn't come through). Unfortunately, my surgeon's office doesn't do that.

Actually, no, Medicare is not the same in all states. There are things called National Coverage Determinations (NCD's), which apply to all states. Then there are Local Coverage Determiations (LCD's) which apply only to the state named in the document. The database of NCD's and LCD's can be found here: http://www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx It's usually easier to go to the website for the Medicare Administrative Contractor (MAC) that covers your state than search the entire database. Go here and scroll down to FIND YOUR MAC about halfway down the page: http://www.cms.gov/Medicare/Medicare-Contracting/Medicare-Administrative-Contractors/MACJurisdictions.html

"Thank you for your concern" (said while interrupting their story of woe). Then change the subject. Immediately.

You don't have to know what is causing your pain, and yes, pain docs can diagnose the same way your primary can. I work for a pain management doctor. He is dual board-certified in pain management and rehab. He is also a physiatrist (a physiatrist is a nerve, muscle and bone expert who treats pain and injuries that affect the way you live and move). Most people are referred to us for chronic pain. Their primary doctor usually has done everything they can for them. Sometimes, the primary doesn't know what is wrong with them, just that they have pain that isn't getting better. Our patients have nerves that are being compressed, or spine problems, or nerve damage from diabetes or other causes. Some of our patients have arthritis, or scoliosis, or even brain injuries that are interfering with the way they move. That's the type of patient that a physiatrist treats. It sounds like you might want to seek out a physiatrist for a consultation. I do want to say, though, that there are pain docs who just dispense medications and don't do anything else. You want a physiatrist that will take a full history, do a full musculoskeletal exam, and explain to you where your pain is coming from. My boss spends at least two hours with each new patient to really understand their history and how they came to be in chronic pain.

A quick lab test can determine your B12 level, so that should be easy to rule out/rule in. You didn't mention if you were seeing your primary doc or a specialist, so depending on your situation, I would also suggest a referral to a good pain management physician or a good physical medicine and rehab (PM&R) physician. They are usually more skilled in determining nerve pain issues than a primary care doctor.

AWESOME!!!

Wow this got weird. How complicated is it to understand that you're asking a pretty impossible question? Unless someone claimed plastic surgery on their taxes and was audited would they be able to answer your question. But then, the answer would only be relevant if you got the exact same auditor that they got, had the exact same surgery, and had the exact same documentation. And, being that we are talking about the IRS, their experience STILL wouldn't matter nor would it be relevant to your situation.