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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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