Got an email from Blue Shield....

This was their response to my inquiry re: WLS. I asked them to send me an information packet and to supply me with any information they can since their site sucks. Can someone translate? Here's the story. My PCP (Internist) is referring me to a WLS surgeon. Who does the "prior authorization"? My PCP or the surgeon? And the surgeons listed below aren't the surgeons my PCP was initially referring me to, but I wonder if these surgeons are what Blue Shield requires? GEEZ, this is confusing. (And I'm sorry I'm asking so many frickerfracking questions.) Ps, I live in one of the NON designated counties, if that makes a difference. Thank you everyone!!!

All Bariatric surgery services must be prior authorized, in
writing, from Blue Shield's Medical Director.  Prior
authorization is required for all persons, whether residents
of a designated or non-designated county. Person's *****side
in Imperial, San Bernardino, Kern, San Diego, Los Angeles,
Santa Barbara, Orange, Riverside or Ventura County, please
refer to the section titled.  Residents of designated counties.
For Persons *****side in non designated counties, services
are covered as any other Inpatient Surgery.

Performed at designated preferred bariatric surgery facilities
and by designated preferred bariatric surgery physicians that
has contracted with Blue Shield to provide the procedure.

The surgeon will supply you with the package that your will
need.

UCSF Bariatric Surgery Center
400 PARNASSUS AVE Suite A655
SAN FRANCISCO, Ca.94143 415-353-3619
Guilheme Campos MD. or Stanley Rogers MD.
With UCSF Medical Center.


Deron Ludwig MD
251 COHASSET RD, STE 120
Chico. Ca,95926 530-891-1651
With Enloe Medical Center.

I have Blue Shield as well.  The way it worked for me is my PCP, also an Internist, submitted a request for a consultation with my bariatric surgeon to Blue Shield.  Blue Shield has to approve the request. The surgeon needs to be within the network that your doctor belongs to.  The letter above I don't think was written by a human being.  I would just ignore this email and work through your doctor.  Find out if the request from your PCP was approved and who they approved you seeing.  You should get notification through the mail.  I don't know how long ago your PCP put in the request. If it's only a few days, be patient, you should get the notice soon.  If it's been longer than a week call your doctor back. 

Blue Shield of California covered my surgery and follow-ups 100%.  I hope you have the same coverage!!

I wouldn't bother with the insurance company directly unless you have to. 

Good Luck!

Ms.Blues

I sent you a PM with my cell phone #.  Call me and I'll explain how the program works with Blue Cross now. 

It's complicated and I'll make better sense if I can verbally explain it to you.  There's a hiccup in Blue Cross due to their lack of contract with Shasta Regional.

Call me................I'll explain it all!  And walk with you the whole way and answer any question you might have if I have the answer!

I just wanted to let you know that I had Dr. Ludwig as my surgeon. He and his staff are excellent at what they do. They are positve, knowledgeable professionals. If you have any questions about them, ask away!

 

Lauren

When was your surgery? I am scheduled with Dr. Ludwig on Tuesday, 7/28 and am getting a little nervous.

My surgery was in 9/06. They still call and check on me and continue to be supportive. Good Luck!!! Email me if you have any more questions @ [email protected]

 

Lauren

I have a copy of the letter I used on my blog. Feel free to copy and use it. Best advice I can give you is to send the letter now to BS, you PCP, and to the coordinator of your medical group now so you have a formal request sent and documented!  Blue Shield paid 100% of my surgery, all my preop testing, labs, psych eval, everything!!!   I only pay $5 office copays!

Hi---I live in Red Bluff and am scheduled to have surgery on Tuesday morning, 7/28---I am having it in Chico by Dr. Ludwig----How is your search for a surgeon going?