Requirements for Blue Shield of California

[cableworth 28]

Has anyone with blue shield of California recently went through the process, what was the requirements?, any help is appreciated. I’m switching over insurances mid process.

[Josallyn 0]

Cableworth,

Ugh, why has no one answered your question! Let me know if you've found anything out. I am also switching to Blue Shield of California next month and am curious to know what the requirement was as far as medically supervised diet goes. I've heard no diet, three months, and six months.

I have a consultation tomorrow with my surgeon, if I get info, I'll keep you posted

[cableworth 28]

Thank you Josallyn.

I looked up some of the requirements on there website and it states that it’s only 3 months of weight management. I haven’t called them yet. My surgeons office will be submitting for approval on January 1st. I just finished my last nutrition appointment. I’ll be meeting with my surgeon on the December 13. I can’t wait. [emoji847]

[cableworth 28]

Josallyn. How far are you along the process?

[KateBruin 344]

I have federal BC/BS but it’s processed under blue shield or sometimes anthem. I had 3 month supervised diet, which didn’t mean crap. All it meant was I had to visit my surgeon or GP once a month. So month one was my consult, month two was GP + pre-op blood, and month three was my final pre-op appt. I also needed a psych consult, to attend a seminar and get a letter from my psychiatrist saying I haven’t used illicit drugs for at least a year and he has been and will continue to treat me.

The psychiatrist letter might have been an extension of my psych consult as I’m bipolar. Little stupid since insurance sees that I fill my meds every month and see my psych monthly. Just a stupid hoop.

[cableworth 28]

Wow. I wish I had blue shield, I would of been done by now. I started in April and still going thru the process.

Thank you katebruin

[nuhtoshuh 1]

I’ve just finished the process and it was submitted for approval today!

It required a three month supervised diet where you set goals and visited once per month to do a weigh in and create new goals. The requirement was to weigh less than you did at the first appointment.

I had to do a psych evaluation, the insurance provided an additional paper for the psychiatrist to sign and I had to have medical clearance from my PCP for the surgery as well. I also had to do a specific type of blood work test required by the insurance too. (Can’t remember exactly what it was called now though!)

This was for the VSG procedure and I am hoping to have it done early to mid January.

Good luck!

[KateBruin 344]

I’ve just finished the process and it was submitted for approval today!
It required a three month supervised diet where you set goals and visited once per month to do a weigh in and create new goals. The requirement was to weigh less than you did at the first appointment.
I had to do a psych evaluation, the insurance provided an additional paper for the psychiatrist to sign and I had to have medical clearance from my PCP for the surgery as well. I also had to do a specific type of blood work test required by the insurance too. (Can’t remember exactly what it was called now though!)
This was for the VSG procedure and I am hoping to have it done early to mid January.
Good luck! [emoji4]

Good luck to you! I’m down a bunch since surgery and developed gastroparesis, a super rare complication, but don’t regret a thing. Good luck in January! I’ll be scheduling a hernia repair. Surgery is the best decision you could make!!

[R3d_Drag0n 1]

I was required to complete 6 months of medical weight management, colonoscopy and endoscopy, psych evaluation, cardiac stress test, and then we submitted for approval. It came in about a week, so that part wasn’t bad. They didn’t specify what kind of weight loss the insurance company expected, just what the surgeon wanted, which was no problem. The low carb, high Protein diet worked really well for me, so I exceeded my loss requirement.

[TGTCEGCC 2]

[TGTCEGCC 2]

[kmn1109 4]

I'm with Blue Shield/Covered California. I was extremely disappointed to learn that my Blue Shield coverage only covers doctors and facilities in a select list, all of which are in Southern California. The closest one to me is 6 hrs away. Even though they have a bunch of bariatric surgery centers listed on their website and the surgeons I tried to schedule appts with are in network, because my plan was through Covered California, I can only go to a doctor who is 6 hrs away.

So if you're reading this thread because you have Blue Shield in California through Covered California, you only have the option of one of a dozen centers in Southern California--nothing north of Bakersfield. If you're "regular" Blue Shield, you have more options. If you're regular BS through your employer, you have to be sure that the employer has not excluded WLS from their benefits (some cheapo employers do that to keep rates down).

[nuhtoshuhh 11]

2 hours ago, kmn1109 said:

I'm with Blue Shield/Covered California. I was extremely disappointed to learn that my Blue Shield coverage only covers doctors and facilities in a select list, all of which are in Southern California. The closest one to me is 6 hrs away. Even though they have a bunch of bariatric surgery centers listed on their website and the surgeons I tried to schedule appts with are in network, because my plan was through Covered California, I can only go to a doctor who is 6 hrs away.

So if you're reading this thread because you have Blue Shield in California through Covered California, you only have the option of one of a dozen centers in Southern California--nothing north of Bakersfield. If you're "regular" Blue Shield, you have more options. If you're regular BS through your employer, you have to be sure that the employer has not excluded WLS from their benefits (some cheapo employers do that to keep rates down).

That’s simply not true. I had the surgery done in St Louis and it was covered under Blue Shield of California.

[kmn1109 4]

Blue Shield covers WLS, but if you have Blue Shield CA through Covered California, and you don't live in Southern Calfornia near an approved facility for covered california members, you're out of luck if you want a doctor who is less than six hours away. Did you get BS through Covered California? We may need to bite the bullet and pay the high regular rates to get the NON-covered California Blue Shield coverage which would allow me to go to the doctor I want who is only 20 mins. away.