Tomorrow is my last weight IN I'm so nervous and upset l unfortunately didn't meet the pre op weight required by blue shield of California (medical),to be approved for surgery. I do have all the other requirements done, I been at this journey almost a year. Even do last visit l lost 6 pounds, but l feel wasn't enough... I just hope once my coordinator summits my paperwork l don't denied..... All l want for Xmas is to be approved????

Edited December 11, 201510 yr by fatmommy1808

What does it state in your policy about the weight gain? My Insurance is BCBS of Al, I gained from May till Nov 213 to 224. I was not denied by insurance but my doctors office is very strict at making me get to 213 again. I have been on liquids , protein drinks and sugar free jello for about 2 weeks. I'm down to 218 and weight in tomorrow! I would make sure you find out what the insurance policy states about weight gain. When I call BCBS everyone is always so helpful and nice! Good Luck.

If you're on Blue Shield Medi-Cal (Medicaid), your requirements may indeed be different than regular Blue Shield. The regular plans don't have a weight loss requirement.

Blue Shield of CA has NO weight loss requirement. Here is a link to their medical policies: https://www.blueshieldca.com/provider/authorizations/clinical-policies/medical-procedures/policy.sp

Look under "B" for bariatric surgery. Patient selection criteria is on page two. Blue Shield also requires that its contracted medical groups (who do the authorizations for most of their members) follow Blue Shield's criteria - they can't superimpose their own criteria. I hope this helps, you appear to have been misinformed.

I hope this helps, you appear to have been misinformed.

If it's a Medicaid plan, which I think it is because she said "Medical" (or "Medi-cal" as it's called in California), then they have their own requirements set by the state, that have nothing to do with the regular Blue Shield benefits.