Blue Cross of California----HELP!

xxnocorexx · 01-17-2008, 07:37 PM

Ok so I just got new insurance with Blue Cross and I want to make sure I go to a primary care physician that supports Lap-Band®. Anyone from Californa know of doctors in the network that are all about it?

destined2befree · 01-17-2008, 07:54 PM

where do you live? I live in socal and I went to st. josephs hospital in orange, ca. my pcp referred me and my whole thing went for 6 weeks start to finish I wnt to the meeting 11/14/07 and was banded on 01/07/08.

mgordon1 · 01-20-2008, 01:03 PM

Hi - I ditto the previous comment. It depends on where you live and what kind of plan you have. I have Blue Cross PPO and my doctor and hospital are great.

IndioGirl55 · 01-20-2008, 03:28 PM

Quote:

Originally Posted by xxnocorexx

Ok so I just got new insurance with Blue Cross and I want to make sure I go to a primary care physician that supports Lap-Band®. Anyone from Californa know of doctors in the network that are all about it?

I have BC of Ca PPO - they require that you go to a center of excellence - I was lucky my doc & hospital both were in network. I was able to go directly to the surgeon- I never went to my pcp to get a referal since I am ppo and can go directly to any doc in my book... I made appoint with surgeon on 5/31 and was approved by 6/20 and had sugery on the 17th of July and due to my age had TONS of pre-op test (mostly cuz i never when to the doctors)

Need more info to be of any help are you ppo or hmo??? Have you ck'd with your carrier to see if wls is covered - some employers have it excluded from what i gather... You need to call them (bc) and find out what your policy states as far a wls is concerned... then go from there...

manykids · 01-21-2008, 03:08 AM

I work for Blue Cross and my daughter got LAP-BAND®. Depending upon whether you have a PPO or HMO you can be covered for this surgery. You need to go to your Primary Physician if you have an HMO and get a referral to a Blue Cross COE (Center of Expertise) to have your surgery at. Cedars Sinai is a COE with BlueCross of California. Any B.C. PPO member should be directed to make an appointment at any of these accredited centers. Refer to your policy contract under Bariatric Surgery. You won't have problems with authorizations as long as you go to a COE to have this surgery. Remember also in California we are lucky to be able to appeal with an outside Review BOard should Blue Cross decline an authorization by the Physician. Majority of times if you meet the criteria as listed in your policy contract, the REview Board will demand that Blue Cross pay for this surgery if they declined it. Where you go is pivotal to getting approved authorization for this surgery.

ronwifey · 01-21-2008, 03:22 AM

Sorry this is kinda off original post...... I'm wondering why there is all these different types of BCBS with different coverages. It seems like if you have BCBS TX it should have same coverage as BCBS of CA. I have BCBS FED Basic and I have no idea what they cover and don't. I searched everywhere for my coverages.

manykids~.....what happens if there is no center for expertise in my area?

manykids · 01-21-2008, 04:13 PM

I understand your confusion and so many have asked this. They are different. BCBS being in Texas is basically one company. One takes care of hospitalization and the other takes care of everything outside of the hospital. Here in California they are totally different companies. They compete with each other for business. So we handle things differently. Since I am not totally famaliar with the procedures and protocol of the one company together BCBS I do not know what their criteria is for finding an approved center for bariatric surgery. I would either check my policy contract online or if you have a handy copy at home check this. Or you can call the eligbility department and find this out from BCBS. This will take away from alot of wasted time. They have guidelines that are set out in your type of policy and coverage and the choices of where you can have this done. Your Customer Service will help you with this. But again if you have your policy contract or access it online under you ID Member number you can read the criteria yourself. Hope that helps a little. Sorry we do things different here being that BC and BS are 2 different insurance carriers.
Many Kids

ronwifey · 01-21-2008, 04:19 PM

Oh.... ok thanks. I found my coverage online and at first it states bariatric is covered then another part said I have to cover costs. I'll just let the Dr's office handle this part of it. Thanks again.

manykids · 01-21-2008, 04:23 PM

I really hope the best for you. You will be so glad you had it. My 17 year old daughter had it day after Christmas and already has lost 23 lbs. Hunger is very controllable now and she has been able to go to school with everyday more energy.
Your Physician's office will always deal with the insurance, and any co-payments you will have with the insurance. Good luck.
Many kids in California!