Blue Cross Blue Shield of California...Question About Approval!!

Hey everyone! My name is Katie, I'm 21 years old and live in New Jersey, though I have BCBS of California insurance. I'm brand new to this site and just had a few questions that I thought you guys could answer better than any doctors or insurance companies.

I have been interested in lap band surgery for a while now; I have been dieting every since I was eleven and could never lose weight. I am now 278 pounds with a BMI of 42. Though I am a young girl, I have been through many diets and procedures, such as Jenny Craig, Diet Center, Weight Watchers, hypnosis and many personal trainer's and gyms. My doctor has been telling me for years that I have to lose weight or I will have serious problems later in life, but I could never really follow through.

Here is my problem right now...I went to my Lap Band surgeon's office last week and everything seemed to be falling in place perfectly. Then, we started talking about insurance coverage, and, though the woman wasn't too sure about BCBS policy in California, she said that if I don't have proof that I followed a diet with my doctor for a six month span over the last two years, I would not be approved for surgery.

Do you think this is 100% true, or should I give it a shot, send in all the information that blantanly shows that I need this surgery (including a doctor's letter), or should I try to follow a physician supervised diet for six months and then give it a shot? I'm a really impatient person, so I want this to happen as soon as possible. But I don't want to be discouraged if I don't get approved for a silly reason.

So, any imput or any advice you could offer would be great. I think I'm going to try and send it in and see what happens, but some support or suggestions would be very much appreciated. Thanks so much.

You need to call your insurance provider and ask exactly what it is they require. That is your safest bet. Different employers can tailor policies to suit, so another with BCBS CA may not have the same coverage you do. Find out, and you can advocate for yourself.

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PCM 7/3/08 Seminar 7/10/08
Upper Gi, Psych,Nutrition, Surgeon 7/25
Tricare Approved 7/31
1st surgery 8/11 thick liver no band
Banded 8/29/08!!! BY:
Dr. Sonny Cavazos, Texas Bariatric

I have blue cross california,and all i had to do was list all the diets i have been on , it took me a total of 3 months to be approved, it would have been les time,but all those test appointments take time,good luck!!!!!!!!!!!!! hit me up if u have any other questions

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Hello - I have Blue Cross of California - It was my Med Office who had all the rules. You can find this info on your insurance card. And yes my Med office required that I go thru the 6 month process. I would get this going asap so you don't waste any time just in case you need it.
good luck - hope you don't have to wait long.

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Jean

PCP BC HMO - referral - 7/21/08, Seminar - 8/12/08
Psych Eval - 9/8/08 , Support group - 9/23/08
Six month Dietician - 7/21, 8/18, 9/15, 10/13, 11/7, 12/8
Meet Surgeon - 1/28/09 , Nutrition Class - 2/19/09
Pre-Op Testing - 2/17/09, Insurance approved - 3/2/09
lost 20 pounds before surgery
Surgery date - 3/23/09
Lucky Losers March 09

I have Anthem Blue Cross Blue Shield of California and my timeline looks like this

August 12th - Info Session
August 21st - Lab work
August 26th - Psychological Screen
August 28th - Psychological Eval
August 30th - Sleep Study
September 5th - Dietician Appointment
September 16th - APPROVAL!!! HORRAY

I called my insurance company and was told by customer no service that my policy did not cover bariatrics, but once my doctors office called they found out that was incorrect. They were able to get a clear concise list of requirements and as you can see the approval took less than two weeks. I wish you the best success.

Every story is different, but here is my information:

I have CALPERS BC/BS Net-Value, which covers bariatric surgery. My insurance required that I complete 6-months of verified weight loss with either a doctor or a nutritionist. Plus, a pysch eval. I completed all that and my primary care doctor sent the documentation to the insurance company. The insurance company approved me to see the surgeon at Alta Bates Hospital in Oakland, CA.

The surgeon has his own requirements, which include attending a 2-hour educational seminar and a 1.5 hour Pre-Op group seminar. Plus complete the medical history application packet. I have completed all that and I am waiting to meet with the surgeon.

The surgeon will decide if I am a good candidate for the procedure and will determine what other tests I need to complete. Then the surgeon submits paperwork to the insurance company for approval of insurance.

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11/11/08 Surgery with a 10cc band
Weight 214, was 254 pre-op
First fill:11/11/08 3cc (lost .5cc from surgery fill)
Second fill: 12/10/08 1.5cc
Third fill: 1/14/09 1cc
Fourth fill: 1/28/09 1.5cc (lost 1cc from 1/14/09)
Fifth fill: 3/17/09 1cc
Total 6.cc

HELP! HELP! HELP!
I have Anthem Blue Cross and I have been working on this since July 2008. I have done everything now they are asking me to get a consultation with the doctor. Please tell me who performed your surgery?

HELP! HELP! HELP! MSK1968

Hey I live in Smyrna, Georgia and I have Anthem Blue Cross and I have been trying to have this surgery since July,2008. I have done everything that the insurance company required and now they want me to have a consultation with the surgeon. Did you have to go thru all of this. I started with my pcp. Who performed your surgery?

My surgery was performed by Christopher Hart. He has a private practice and he also works with True Results on Peachtree Dunwoody just passed Hammond Drive. He has a good reputation as a surgeon. However, if you want to have interaction with your surgeon he may not be your best choice. You will meet him briefly prior to surgeon and you will not see him again. All fills are completed by the nurse practioner who are fine. I wish you the best.