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Insurance changed!



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My insurance changed! I started my journey November 2018, with a consult with my (then) surgeon at Riverside Medical Clinic. With my (then) insurance, Anthem Blue Cross ***, I only needed 3 month (12 continuous classes) supervised nutrition/weight classes. As of now, I finished 10 out of my 12 classes. Last week I found out my insurance changed to Anthem BC PPO and they now require me to go to a Dignity Health Facility to be covered 100%. Well okay... I call my nearest Dignity Health bariatric surgery center to find out more.

I was told at Western Bariatric (St. Bernadine -- San Bernardino, CA) that I needed 6 months of classes and basically restart my journey. I started to bawl my eyes out! I'm 25 (November birthday) and I'm getting real close to end of my insurance coverage under my parents. When I had started my journey, I was hoping to have my surgery by March or April. So, I'm worried about having my surgery before my cut off. Anyway, I sucked it up and started making calls. I attended their Seminar, where we filled out new patient packets and made copies of our insurances.

The next step is to wait for a call to schedule my consult with their surgeon. I was told that the consult would count as 1 of the 6 months of weight classes.

Does anyone believe they will accept my 3 months of classes Ive already taken? (and maybe only need 3 more months to meet the 6mo requirement?)

Will they consider the original surgeon consult from November 2018 too (as part of the 6 months wight management?)

I'm honestly hoping that Western Bariatric will consider my start (Nov.) to my current (Feb.) for a total of 4 out of the 6 required months. I didnt want to be set further back, but ill take whatever they'll take and Im hoping for the best!

Can anyone can give me some insight? Similar situations? Anyone go to Western Bariatric? I'm really anxious.

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I have zero insight on your insurance issue but I just wanted to say I’m sorry for your setback. I will say I went through an extensive program to be prequalified for my insurance. And when I finally went to the surgeon I still had to do all their requirements which is an additional 3 months. So they may want you to check all their boxes but I hope not. Good luck!!

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Oh that's a shame. It seems like they'd count your already completed 3 months of classes as long as they were consecutive without gaps. I had to wait an extra 3 months because my insurance was changing and I didn't have time to get six months of supervised medical weight loss management under my prior policy and my new policy didn't require it.

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Why are your insurance companies so mean with so many hoops. You pay for a service from them they shouldn't ask you for so much

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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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      Officially here for a long time, not just a good time💪
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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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