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Blue Shield of CA PPO



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Hi, wanted to see if anyone has gone through blue shield of CA PPO process. After years of dieting with little sucess, I am seriously thinking about getting the gastric sleeve done. But I'm afraid I won't qualify...I am right at a 35 BMI. So wanted to connect with other people that have tried to get qualifed with this insurance. Otherwise, I do think my alternative would be to go to Mexico. Thanks!

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I'm not familiar with that PPO, but you may qualify at a lower BMI if you have other conditions such as blood pressure, sleep apnea, pre-diabetes, etc.

Good luck.

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I have BS of CA PPO and also got the gastric sleeve. If you have a bmi of 40+, then you qualify. If you have a bmi of 35 with at least one comorbidity, then you will qualify too. They require a psychological evaluation, nutritional support, proof that you have attempted to lose weight in the past, particularly within the past 3 - 6 months (primary doctor can provide that information - pretty much just showing weight loss and weight gain again). I also had to do multiple tests, but that was due to my surgeon's requirements, not insurance. My surgeon's office told me that Blue Shield of CA is one of the easier insurances to work with. They don't make you have to jump through as many hoops as other insurances. Once my paperwork was submitted along with all my requirement documentation, I got approved in less than a week.

Here is a link to a pdf on Blue Shield of California's website. It shows the requirements for weight loss surgery, to help give a more thorough idea.

https://www.blueshieldca.com/bsca/bsc/public/common/PortalComponents/provider/StreamDocumentServlet?fileName=PRV_PA_Bariatric_Surgery.pdf

Edited by River Moon
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@River Moon wow! thank you for all of this info!! from your initial consultation how long did it take to book your surgery? i haven't seen my pcp in the last 6 months, just saw him the other day to get his thoughts on the sleeve.

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7 hours ago, Tammy N said:

@River Moon wow! thank you for all of this info!! from your initial consultation how long did it take to book your surgery? i haven't seen my pcp in the last 6 months, just saw him the other day to get his thoughts on the sleeve.

You're very welcome! :) I had my first consultation around late April, and had my surgery July 7th. Once I had the consultation I just went head-on into the process and started scheduling all my appointments and testing dates. My surgeon had me go through a lot of tests like an upper endoscopy, cardiopulmonary stress test, chest xray, and covid test (day before surgery). I already had my gallbladder removed several years ago so I didn't have to have an ultrasound for that. I wish you luck in your journey. You'll do great! It's the best decision I've made for my health.

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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.
      · 1 reply
      1. LeighaTR

        I hope your surgery on Wednesday goes well. You will be able to do all sorts of new things as you find your new normal after surgery. I don't know this from experience yet, but I am seeing a lot of positive things from people who have had it done. Best of luck!

    • 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.

    • CaseyP1011

      Officially here for a long time, not just a good time💪
      · 0 replies
      1. This update has no replies.
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