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Blue Shield of California

Going2lose

By Going2lose, in Insurance & Financing

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Going2lose    9

Going2lose
Posted

See the link for more details but the expert below is from Blue Shield of California's website stating the requirements for bariatric surgery are:

"Patients should have documented failure to respond to conservative measures for weight reduction prior to consideration of bariatric surgery, and these attempts should be reviewed by the practitioner prior to seeking approval for the surgical procedure (e.g., Weight Watchers, Jenny Craig, Optifast, MediFast). The timing, intensity and duration of the preoperative timeframe should be individualized and left to the discretion of the patient and provider. However, given the elective and life changing nature of these procedures, and the necessity of proper education and instruction in the lifestyle changes inherent in both the immediate and long term postoperative management, it is recommended that three months elapse between the initial bariatric consultation and the date of surgery. "

But when I called the number from my insurance card I was told that the requirements were still 6 months supervised diet. I am assuming the website is right and not some random person that answers a call....or am I crazy???

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

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lolarose13    147

lolarose13
Posted

Hi, I was approved with Blue Shield of California PPO plan and they did required 6 months of diet appointments plus all the requirements mentioned in those guidelines. I think the BS of CA HMO Plan does not require the 6 months diet, but for PPOs is still a requirement.

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H-M-O plan.

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Deletemyacct    39

Deletemyacct
Posted (edited)

I have the same insurance & I was told I don't have to meet any specific diet requirements except that i meet the bmi requirements & have documented other weightloss attempts. I did ask to see my benefit plan documents & I was directed to where i can find it & it just give the pay schedule & that I'm covered. The place I'm going to confirmed the insurance didn't have any specific requirements so they said they'll have me do the 3mths. My 1st appoint is Wed & I collected all documents i can find of weightloss attempts I've had in the past. All wellness initiatives I've participated in at work etc.. I also wrote a summary of all the diets I've tried , loss & gain table with dates. I want to be as prepared as possible. Btw, just to confirm, I called my insurance multiple times different days & times & all reps said the same thing & just get pre-authorization first.

We'll see!

Blessings!

Edited by Deuel30

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Going2lose    9

Going2lose
Posted

I have the same insurance & I was told I don't have to meet any specific diet requirements except that i meet the bmi requirements & have documented other weightloss attempts. I did ask to see my benefit plan documents & I was directed to where i can find it & it just give the pay schedule & that I'm covered. The place I'm going to confirmed the insurance didn't have any specific requirements so they said they'll have me do the 3mths. My 1st appoint is Wed & I collected all documents i can find of weightloss attempts I've had in the past. All wellness initiatives I've participated in at work etc.. I also wrote a summary of all the diets I've tried , loss & gain table with dates. I want to be as prepared as possible. Btw, just to confirm, I called my insurance multiple times different days & times & all reps said the same thing & just get pre-authorization first.

We'll see!

Blessings!

Do you have BS CA P P O or H M O? I have P P O but I am nervous that the 3 month requirement is only for the H M O, but hopefully not!

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Going2lose    9

Going2lose
Posted

I finally waited on hold long enough to speak to a supervisor and they agreed that the documents that their agents were using were outdated and the requirements had changed. BS of CA no longer require 6 months supervised diet -- only the recommended 3 month wait.

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Going2lose    9

Going2lose
Posted

Good luck to you too! I went to my first appointment on 6/9 and went to my psych eval on Thur. I don't know when I will have surgery as originally they said I had to wait 1 year after giving birth which is mid-October. They have are starting to back off this requirement though as this is NOT pregnancy weight...so...more to come, but hoping for a mid-August or early Sept date.

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Deletemyacct    39

Deletemyacct
Posted

6/9 my daughter's bday! Cool, I'm hoping for a Sept surgery, sept is my bday mth. Let's keep each other updated sounds like we may surgery around the same time. I'd love to keep in touch.

Blessings!

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Go To Topic Listing Insurance & Financing

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

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

      bellaamey

      https://alluniqueguide.com/java-burn-coffee-reviews/
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