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Blue Shield CA and the insurance update

Shanni1269

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Shanni1269    73

Shanni1269
Posted

I know it has been a discussed ALOT about Blue shield CA changing their policy July 31, 2015 to no longer requiring the 6 months weight checks. I had my first apt with the surgeon today and they told me I was WRONG. I had the policy change printed out as well as the pre-auth form and the coordinator didnt even want to look at it.

Now I hate being told I am wrong after I have researched a topic....so now ITS ON!!!

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lolarose13    147

lolarose13
Posted

Hi, so do they require this or not? I'm currently have Aetna but I changed my benefits to Blue Shield CA starting April 1st. I know they will covered the procedure but I don't know about their other requirements. Do you have a website or document I can look at? Thanks!

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Shanni1269    73

Shanni1269
Posted

I just spoke to probably the most helpful person at Blue Shield and no..it is no longer a requirement. It is up to the discretion of the patient and the provider

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Shanni1269    73

Shanni1269
Posted

https://www.blueshieldca.com/provider/content_assets/documents/download/public/bscpolicy/Bariatric_Surgery.pdf

Here is the link of the policy my insurance gave me

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littlered12973    5

littlered12973
Posted

Hi there, I too am in California and I have Blue Cross/Shield PPO. I have a surgeon who has been doing this for 20 years. In my office, there is one nurse and one insurance coordinator. It was my experience that my office seems to have the process of insurance approval down pat. I almost feel awkward because my journey has been really fast. I know that is not normal. I would really check around to see what office can help you out. From the date of my first consult to my surgery was a month. I had done the diet and met the requirements. I wish that everyone had the same experience because I know first hand that this is a life saver. Both of my parents have had WLS. Best of luck...remember that you can shop around for the best doctor.

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kaitlynm    335

kaitlynm
Posted

I have BCBS of TX and had my surgery last fall. My Doc's office also told me that I had to do the 6 month diet, but when I called BCBS they told me that they no longer required that. Saved me a lot of time and money to make that call.

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Shanni1269    73

Shanni1269
Posted

I have gotten confirmation from my insurance that the 6 months is no longer required, but the Surgery Coordinator will not listen to a word I say or even look at the policy from my insurance that I printed out and brought with me to the appointment. I am not trying to tell her she is wrong, just that she doesn't have the most updated information for MY insurance...she is one of those types that doesn't like to be wrong. Like I couldn't possibly know anything about the subject or done any research on my own behalf...like someone couldn't know more than her about MY insurance. Problem is I rely like this surgeon and don't want to upset her because she has my scheduling in her hands..lol.

Now a rep from my insurance is trying to get ahold of her to confirm and until then I keep doing my pre-op instructions.

I have NUT Tuesday, Psych Thursday and an appointment with my gastro doctor the following Monday (still need to schedule the Endoscopy after that). Then that's it...they wont schedule me to do insurance approval because Coordinator is instant that I need 6 months. I have 2 months and still have the next 4 on the schedule...but I REALLY just want to submit to insurance.

Wish me luck

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2goldengirl    2,076

2goldengirl
Posted

I have gotten confirmation from my insurance that the 6 months is no longer required, but the Surgery Coordinator will not listen to a word I say or even look at the policy from my insurance that I printed out and brought with me to the appointment. I am not trying to tell her she is wrong, just that she doesn't have the most updated information for MY insurance...she is one of those types that doesn't like to be wrong. Like I couldn't possibly know anything about the subject or done any research on my own behalf...like someone couldn't know more than her about MY insurance. Problem is I rely like this surgeon and don't want to upset her because she has my scheduling in her hands..lol.

Now a rep from my insurance is trying to get ahold of her to confirm and until then I keep doing my pre-op instructions.

Wish me luck

Ask to speak to the Office Manager. Explain your situation and that you can't get past the Insurance Coordinator. That may help.

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Shanni1269    73

Shanni1269
Posted

i tried...waiting to hear back

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Shanni1269    73

Shanni1269
Posted

So the insurance coordinator finally received the right information regarding my insurance but now says they are going to use the recommended 3 months from initial consultation before sending approval anyways. The surgeon said NOTHING about that. He said if my insurance didn't require weight checks I could be ready in a matter of a couple months. I think she is punishing me for knowing more about my own insurance than she did and I was persistent in getting the information to her.

I need to call the office to clarify but I am so angry I am afraid I am going to say something that will just piss her off and she will prolong my process even more. I really like this surgeon but do not know if I can deal with this person.

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Shanni1269    73

Shanni1269
Posted (edited)

O my insurance called me and they have (at my request) tried to call the coordinator at the surgeons office over 10 time and left messages to get her the updated insurance requirements for Surgery. They said they have NEVER returned their calls. She hasn't returned any of mine either. Today I faxed some of my documents over to her and requested she call me ASAP.

It seems my options are deal with her...

Change surgeons (and offices)...

file a grievance...

What do you all think I should do???

Edited by Shanni1269

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kaitlynm    335

kaitlynm
Posted

I would talk to the surgeon and tell him about her behavior. It is his office and reputation and he needs to control his staff. If that doesn't work, then switch surgeons.

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Go To Topic Listing PRE-Operation Weight Loss Surgery Q&A

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      I am new here today... and only two weeks out from my sleeve surgery on the 23rd. I am amazed I have kept my calories down to 467 today so far... that leaves me almost 750 left for dinner and maybe a snack. This is going to be tough for two weeks... but I have to believe I can do it!
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    • Doughgurl

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      Hey everyone. I'm new here so I thought I should introduce myself. I am 53y/o and am scheduled for Gastric Bypass on June 25th, 2025. I'm located in San Antonio, Texas. I will be having my surgery in Tiajuana Mexico. I've wanted this for years, but I always had insurance where bariatric procedures were excluded. Finally I am able to afford to pay out of pocket.  I can't wait to get started, and I hope I'm prepared for the initial period of "hell". I know what I have signed up for, but I'm sure the good to come will out way the temporary period of discomfort and feelings of regret. I'd love to find people to talk to who have been through the same procedure or experience before. So I look forward to meeting you all. Hope you have a great week!
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    • Alisa_S

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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.
      · 1 reply
      1. LeighaTR

        LeighaTR

        I hope your surgery on Wednesday goes well. You will be able to do all sorts of new things as you find your new normal after surgery. I don't know this from experience yet, but I am seeing a lot of positive things from people who have had it done. Best of luck!

    • Alisa_S

      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

        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.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

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

    • CaseyP1011

      CaseyP1011

      Officially here for a long time, not just a good time💪
      · 0 replies
      1. This update has no replies.

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