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BCBS-CA meeting requirements



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I have BCBS-CA PPO. I had my first appointment yesterday, i have to have 6mths of nutritional visits. I have to show weight history for the past 3 years, I dnt know if I have all 3years. I have a BMI of 43. I will meet the requirements by end of November 2016. What were some of the challenges you experienced with meeting the requirements for the surgery? I am also using the OBand center which i believe is out of network, but they were not concerned. Share your experience getting approved or denied & appeals?

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Hi! We have the same insurance.

This is what my doctor submitted for me to get a lap-band removal and convertion to sleeve:

-6 months diet

- attempted of non-surgical weight lost (gyms, other diets, weight watchers, etc)

- 1 nutritional visit (recent)

- Psychological evaluation (with MPPi test)

- letter of recommendation from surgeon with current weight and height.

- in my case, my BMI was 35, so I needed 1 commorbities (I have several), so I submitted medical records and medication list. If your BMI is higher than 40, you don't need this.

I'm having a lap band removal, so in addition I needed to provide all documentation from lap-band surgery, follow up and complications.

I was approved in 24 hrs and I'm having the surgery in a BCBS Center of Excellence. I had a great experience with the insurance company. After the approval they even called me to see if I had any questions about the surgery. Their customer service is awesome and I'm hoping you will have a great experience with them too!

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Hi! We have the same insurance.

This is what my doctor submitted for me to get a lap-band removal and convertion to sleeve:

-6 months diet

- attempted of non-surgical weight lost (gyms, other diets, weight watchers, etc)

- 1 nutritional visit (recent)

- Psychological evaluation (with MPPi test)

- letter of recommendation from surgeon with current weight and height.

- in my case, my BMI was 35, so I needed 1 commorbities (I have several), so I submitted medical records and medication list. If your BMI is higher than 40, you don't need this.

I'm having a lap band removal, so in addition I needed to provide all documentation from lap-band surgery, follow up and complications.

I was approved in 24 hrs and I'm having the surgery in a BCBS Center of Excellence. I had a great experience with the insurance company. After the approval they even called me to see if I had any questions about the surgery. Their customer service is awesome and I'm hoping you will have a great experience with them too!

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Awesome! Thank you for sharing, that gives me hope!! I am so excited & looking forward to the next steps:)☺

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@deuel30... Using an out of network usually means more money out of your pocket, ask about that... They told me any doctor that recorded your weight will work, a Gyn, a primary care etc... Are you getting a lapband?

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@ so far they said I dnt have to pay anything out of pocket. All appointments are convered all the way to the procedure as everything will be done at the Oband center. I was initially interested in the band but after my first visit I'm really leaning towards the sleeve. I dnt like the idea of the foreign object & the adjustments (I hate needles) & the possibility of having the foreign object for life. I like the sleeve as i have 100lbs to lose & a more permanent solution.

Thank u, I will use my gyn records

Blessings!

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@deuel130... As a nyer I tend to be a bit skeptical of things, I should keep my mouth shut... I just have to say the Oband centers are on the radio here with an ad every 2 seconds... Anything medical care advertising that much makes me want to run the other way... Having a procedure at a center isn't a good idea, they just don't have the resources in the event there is a complications... This is surgery you want to set yourself up for optimal conditions... A center just can't provide the level of care a hospital can... These Oband centers are very new, what is the doctor's level of experience?...

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@ I've only had my first appoint. I haven't gotten ask many questions but, this is something I will start inquiring abt next appoint. I plan to also call my insurance & ask questions to get clarification on everything..Thank you!

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@ I've only had my first appoint. I haven't gotten ask many questions but, this is something I will start inquiring abt next appoint. I plan to also call my insurance & ask questions to get clarification on everything..Thank you!

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I too have BCBS CA PPO. I was told anything out of network wouldn't be paid. The surgery is covered 100% if I stay in network and they prefer that you use a BSBC center of Excellence. I still have to pay for the specialist appointments and hospital stay. As stated by another member, I'm weary of those type of clinics, especially those that advertise on the radio. They come across as infomercials. Too good to be true! Good luck and please be safe!

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Edited by kembfly

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@ oh yes, I really appreciate your advice. I really want this but want to start of right & not waste precious time by not being fully informed. I also started googling reviews from patients who used that center. This is a holiday weekend so I will have to wait till Tuesday to contact my insurance.

Thanks again!

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I called my insurance & spoke to 2 different reps & 2 separate occasions & not much is required. They stated the surgery is covered as long as it's for obesity meeting the bmi requirements. I've set up an appointment to see an in network doctor. If I dnt have to wait 6mths I would be elated

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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.
      · 0 replies
      1. This update has no replies.
    • 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.

        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.

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    • KimBaxleyWilson

      Three months and four days ago... I was in Costa Rica having a life changing surgery! Yesterday we had a followup visit with Dr. Esmeral via video chat and this morning my middle number changed.  I'm down 47lbs and two pants sizes. I can wear a Large tshirt for the first time in like... 14 years! Woot!! Everything is going great. I have zero regrets. I went down to the riverwalk with a friend and walked 2 miles on Monday without even getting fatigued. And no more snoring or chugging pickle juice for crazy leg cramps! I need to go to the gym more... I'm making new shirts next week so that will motivate me. LOL But I'm also just not as TIRED all the time! I have a LONG way to go...but seeing the progress on the scales and in the mirror is a huge motivator!! Thank you all for cheering me on and supporting me!!
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