Geez, I've just started thinking about WLS and just got insurance and the runaround has already started.

I called the 3 bariatric centers in the closest city to me so I could attend a seminar and none of them accept my insurance. One accepts Blue Shield PPO, one Blue Cross, but no HMOs. I'm guessing I'll have to go to LA or Fresno. What if there are no providers around that accept BS HMO?? How can they cover it if there is not a provider??

I called BS and they said I am not covered UNLESS medically

necessary....HA, DUH. It's like she's been trained to discourage it from the start. The way she said it. Anyway, when I asked her who they use she told me I have to be approved through my medical group!! Geez, I just want to attend a stinkin free seminar, I may not even WANT to be approved. This has already been too much for my stress level:unsure:

I guess from here I'll see my PCP, start a 6 month diet and ask him where we go from there.

Cindy T

A little update...I called my Medical Group and to ask where they send people for bariatric surgery seminars and they said my PCP must submit an authorization and I then I can attend an informational meeting at their Health Center. I see my PCP this morning at 8:30 and will be asking for just that:wink2:

Cindy T

Hi, I am from Bakersfield also, and I went to a seminar at the Mercy hospital on Truxton. I just called the number and told them I would be attending... I didn't need any PCP referral at all as the seminars DONT usally cost anything to insurance co's.

Shalee, thank you so much for responding! So nice to someone from my area! And congrats on your success!!

I tried to go to the Mercy seminar, but I asked her if they took my insurance and they don't. Wouldn't do me much good to attend if there's no chance I'll have the surgery through their program.

I saw my PCP today and he's referring me to the Medical Groups seminar at Bakersfield Family MC. The good news is he has oredered a bunch of testing since I've not been under a doctors care. Chest X ray, ultrasound on my arteries, EMG, EKG and blood work. Hopefully I'll have some of these tests will also satisfy some of the bariatric testing.

The PCP said that insurance will deny first and tell us everything they will need to approve and we will work from there. I specifically asked about my lack of a 5 year medical history and he didn't seem concerned.

So, at least I feel like I've began the process.

Cindy T

Hi, Good luck with all your pre Op testing. I go in next week to see my PCP for a new round of tests to check my blood sugars, and hopefully the type 2 diabets they found at my Pre-Op testing will be gone. I also have to call around to see if I can find a new Band Dr, Not that I want to, But One that will take and BILL in network my insurance. My Dr is Great, love him, But they bill ouot of network and I have neded up paying almost everything. and my fills are $350.00 and well I have insurance that would cover it so I want to utilize it.

I am new to this area, only 1 year here, don't really know anyone out here, So nice to chat with you.

Kelly

I bet your diabetes in gone!! Keep me informed.

There are several docs in the area. I bet you can find one thats in network.

Weocome to the area!!!

Cindy T

Cindy,

I'm in Porterville. It is nice to see a "local". I am almost insured "long story" and it will be a Blue Shield PPO. I have been to 2 seminars. One in January in Visalia and one in February down in So. Cal. with JourneyLite. I really liked Journeylite but it is about a 6 hour drive round trip so I have been looking at doctors and groups in Bakersfield (only 45 min each way). Can you tell me the name of the Doctor or group that you spoke with that works with Blue Shield PPO? It would sure help me a lot!!

Good luck to you on your journey!!

Oh Gosh Happy Loser, I go to Porterville often! I play bingo at the casino at least once a month. I used to go a couple times a week, but finances have changed, so I can't go as often.

Bariatric Solutions takes BS PPO. They work through San Juaquin Hospital. I think they have a GREAT program and that would be much closer like you said.

Let me know how you like it:biggrin2:

Cindy T

Cindy thanks SO much!!! I am going to contact them today:smile:

Ladies, Make sure you ask whomever you choose if the bill in Network. My Dr's office doesn't and I am appealing to the insurance Co. My insurance coveres WLS but they are denying it becasue Dr's office wont bill in network, he said he wont get paid very much if thats how they bill. It covered all the hospital expenses except for my co-pays. and right now my fills are going to cost me $350.00 each, so as much as I love my Dr I think I am going to look around town and see if there is another one to take me and that will bill in network.

Good Luck

Shalee

Thanks for the tip!! I will be sure they bill in network!!

Thanks Shalee!! For me, I have an HMO, so going out of network is not an option for me. If you have BS PPO, try Bariatric Solutions at San Juaquin Hospital.

Happy-did you check with them?

Cindy T

I'm waiting to call until I get my insurance card. I have already been to a couple of seminars and know this is the route I want to take so I figure the next group I meet with, i want to be ready to get started. If they refuse to bill In-Network i'll be looking elsewhere. It seems silly for them to be In Network but to not bill that way.

Thanks for asking, I'll keep you posted on my progress.

I have United Healthcare HRA Plus. and when billed in network they cover 90 % So yes I have to find a Dr that bills in network.... $350.00 a fill is hard to pay out....

Hi Ladies! I have BC/BS and Dr. Karen MacKenzie in Visalia takes that insurance as well, I believe both HMO and PPO.

Hi Lauralee, I actually went to a seminar by the doctor you mentioned way back in January. At the time she mentioned that she did not have the staff to get pre-authorization from insurance companies so it would be up to me as a patient to do so. That really overwhelmed me. But, I still don't have insurance and thus have yet to have my surgery. I am with a new employer and will have insurance benefits starting the 1st of March. So, maybe then I can revisit Dr. McKenzie. Regards