Question:
Help deciding between Kaiser and Blue Cross.
— mlovesh (posted on June 1, 2003)
June 1, 2003
I have been approved by Kaiser -it took about 9 months now I wait because I
need to get approved by the doctors they gave me to approve me Pacific
Baritric(sp) anyway I have jumped thru all of those hoops so far except the
appts with those drs. who could still denie me if they want this has added
another 3months. Also I live in no ca they are paying for it done in san
diego 2 weeks of work gone for my husband . I have always been happy with
the care I've received at Kasier and know their system. I have a bmi of 50
and no comorbities. I hope this helps
— Anne L.
June 1, 2003
I'm not sure which Blue Cross plan you're referring too, but I have Anthem
Blue Cross Blue Sheild KeyCare PPO 25 and it is amazing! I didn't have to
deal with the insurance co. at all. To qualify, your BMI must be a 40 or
above. Mine is 41, I have no comorbities and was approved over the phone
by the Doctors office! Just check out the Blue Cross plan you have
available and make sure they cover Obesity surgery before you make any
decisions. Good Luck!
— Shelly R.
June 1, 2003
HI, Melissa
In my opinion,by the time you jump threw all the hoops with kaiser the
surgery could be done. I know a few people going threw kaiser and they hate
it. I started with them then I has the opportunity to switch and I jumped
at the chance. Im now 11 days post-op and feeling great. when I started my
process in november I could have had my surgery in febuary but had to
change my date because things came up so I chose
to have it in may. Im in the SF bay area and I chose DR. Estakari in
Pleasanton She's very good and soon as you do the requirments (which every
has)it could be very soon. With kaiser they take anywhere from 9 months Ive
heard to longer
— TCP1918 B.
June 1, 2003
HI Melissa, I forgot to tell you that I was approved with blue cross in 5
days and I never had to deal with the Ins co. I didn't have anything wrong
with me but weight,I weighed 237 and have mild back pain some days
Good luck
— TCP1918 B.
June 1, 2003
Hi Melissa~ I have Blue Cross and was approved within 2 days from the time
my surgeons office submitted my request. I have no life threatening
co-morbs and a BMI of 40.5. Good luck.
— Maggie M.
June 1, 2003
Like some of the others have said, not all BCBS policies are created equal,
so don't assume they will cover WLS. BCBS also typically does not cover a
DS, so if that is what you are considering don't go BCBS.
<p>You really need to get a hold of the policy booklet for the plan
you would get. Look in the exclusions section for treatment of weight
loss. Ideally it would say that treatment of any sort for weight loss is
not covered except in the case of Morbid Obesity and Disease Etiology (in
other words you meet the definition of medical necessity). If you have at
least a 40 BMI and some significant co-morbs you would likely not have a
problem with BCBS, but only they can make the final decision. They require
a psych eval and detailed diet history, although they accepted it from me
and I did not have to provide proof, but not sure all reviewers are the
same. I was sort of a slam dunk at 63.8 BMI and a bunch of co-morbs
including sleep apnea.
<p>Good luck but be cautious of changing to BCBS unless you know for
sure that policy covers WLS. Otherwise you are better off staying with the
beast you know.
— zoedogcbr
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