Insurance question - Blue Shield of California

Hi everyone,

I am trying to get approved for lap band surgery and mostly hang out on the lap band board.  I am having to change insurance companies on July 1. If  I don't have surgery in June, I will have to start over trying to get approval from Blue Shield of California.  My questions are: Has anyone had BSofCA HMO?  What were their criteria for approval?  6 month supervised diet or 6 month nutrition consultation?  did you have to lose a certain amount of weight?  how quickly did you get approved?  do they approve for inpatient or only outpatient?

I am trying to get this info through the broker too but any first hand experiences would be useful.

Thanks so much,

Katie

I don't know about the diet or nut stuff, but if there criteria isn't the same as the NIH then you can probably file a grievance against it to be referred for surgery. I know Kaiser's criteria is stricter than the NIH & my Dr. wouldn't refer me, but once I filed a grievance they referred me. I think it's a 40 bmi w/no co-morbids or 35 bmi w/co-morbids.

You might want to read this as well.

HTH

I have the HMO Blue Shield of California coverage and was approved with the first letter. I didn't have to do a 6 month supervised diet or lose a certain amount of weight due to the insurance. All the hoops were the surgeon's and not the insurance company's.  My approval was quick too.  I believe it was two months before surgery and I could have picked an earlier date.  I was also an inpatient.  

Good luck! I hope you get the coverage you need with a surgeon you like.

That's good to know.  I'm hoping to have surgery in June on my current insurance but if not I am hopeful that my new insurance will be prompt.  Thanks for your response and congrats on your surgery.  Hope your recovery is quick.

Katie