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Health Net Blue Gold



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I carry this insurance and wondering if anyone has used the same for their surgery. I meet back with my referring dr. on the 28th and was wondering how others liked Health Net Blue Gold. I am on the end of a 6 month waiting period.

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It's a narrow-network product, and I believe it's only offered in northern CA. here in the bay area, which means your two sites for surgery ought to be either Valleycare or Summit in the east bay, UCSF in SF, or Mercy Methodist in Sacramento. The same criteria apply for approval of surgery; here is a link to the policy: https://www.healthnet.com/static/general/unprotected/pdfs/national/policies/BariatricSurgery.pdf

They do NOT require six months waiting period, nor have they since this policy was updated in May 2015, however

"Patient has made a reasonable effort to lose weight and there is documentation that these attempts at dietary control have been ineffective in achieving a medically significant long-term weight loss.". A psychological evaluation is required. Their criteria for individuals with a BMI between 35 and 40 are pretty stringent.

All of these details are on pages 3 and 4 of the policy.

Health Net requires that its delegated medical groups (Brown & Toland, Hill, Mercy, etc.) follow Health Net's criteria. This means that if your medical group says that you need to anything beyond what is mentioned in the criteria, they are incorrect. Your surgeon will have specific requirements for preop diagnostic testing, such as an EGD and/or upper GI X-ray, a sleep study, or an EKG, and that's fine, those are diagnostics your surgeon needs and not subject to the health plan or medical group's policies.

I hope this helps!

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wow thank you 2goldengirl you are so informative. I live near Sacramento and my Dr told me he would refer me to the appropriate surgeon after I completed Dignity Healths' requirement which was physical therapy 2 sessions to see if I will be able to workout, nutrician class, completed, doing either weight watchers or myfitness pal, i do track on my fitness pal and to attend a seminar on barriatric surgery which i did at the Methodist location. I have no clue who the surgeon would be although they ususally from the woodland office refer to Dr. Laura Machado but she does not take my plan yet. So, with that all said. I just wonder why I had to go through this whole 6 month ordeal? It started in July and well, I will be meeting back on Jan 28th? i already have sleep anpea and a 40 Bmi, a bad knee so he said I qualified however needed to wait before he referred?

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      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
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      1. LeighaTR

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    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

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        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

      Officially here for a long time, not just a good time💪
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