Blue Cross Of Ca - Hmo

June 14, 2005

Hello,

I'm a new member. HI all. Okay - so I have Blue Cross of CA - HMO. I went to my family doctor and requested a referral to a weight loss surgeon to discuss lapbanding. My doctor tells me he knows nothing about lapbanding but he does know the surgeon my insurance has a contract with (Dr. Callory - spelling? - in Poway, CA). I tell him I know lots about lapbanding and am convinced it is the way for me to go and that I would be a successful candidate as I am 100 lbs. overweight, a bmi of 40, and a comordibity disorder (PCOS). We discuss other problems (I am flushed half the day - he says I'm hypglacimic - no tests - he just knows cause he is so smart - irritated with my doctor). So he leaves the room, nobody comes back, then I walk out in the hallway and said hello? A nurse tells me that I will receive a letter within two weeks from my insurance company telling me if I can go see the wls doctor. I said what??????? Why can't my doctor give me a referall just to see the other doctor, I have to go through my insurance? They said yes. I find this a bit disturbing and wonder if I'll get refused. I bet I do because my doctor didn't take the time to document anything I told him.

GRRRRRRR. Any advice?????? I'm going to contact the doctor myself I think.

Thanks,

Sharona.

Charlie · June 14, 2005

Unfortunately, you are being held hostage by your insurance company. HMO's are very strict in who you see and where you go. The Dr.'s get paid to not refer to specialists and you may have to "play the game". Is the Dr. you saw your PCP? You can write to your insurance company, explaining your situation and medical condition to see if they will pay for surgery. I just gave up and paid for it myself - and took the tax deduction. GOOD LUCK........

La_madam · June 14, 2005

I wish you luck with Blue Cross

I have Bule Cross Of Ca PPO and they told me no way do they cover the Lap Band, regardless of co-morbitities or not. However the good news is that Blue Cross is now covering it in other states like New Mexico, Tennessee and a few others so hopefully Blue Cross of CA will follow suit. I did not want to waste time trying to fight with them or appeal, I am glad I did not, 14 months later self paying going to Mexico Iam down 93 lbs

Alexandra · June 14, 2005

Sharona, you should call your carrier directly and ask them if what your doctor is doing is appropriate. He should, of COURSE, be able to give you a referral based simply on his judgment that you need to see a specialist. If he's unwilling ro let you explore this avenue then you should see a different PCP.

And I have heard that Blue Cross of CA is now covering the band, though I don't know if it applies to both the PPO and the HMO plans. You should ask them about that when you call as well.

Good luck!