Blue Shield of California HMO Lakeside

My coworker had this experience with Blue shield of california Lakeside HMO getting her authorization approved by the medical group for a surgeon consult.

She went to her primary doctor and expressed her interest in a surgeon consult for gastric bypass surgery with Dr. P Quilici in burbank. The primary care Dr said ok, and that she would put the referral for her since her BMI qualified at 46.1. It took the medical group about 2 weeks to tell her that the authorization was denied for a surgeon consult but instead referred her to see Dr. Alwin Lewis in Burbank. The day I found out it was denied by the medical group, Lakeside, she filed a grievance with the insurance company, Blue shield of California (since they are "over"  the medical group). She wrote a letter to the insurance with her proof of weight loss attempts, and problems that she has physically. Blue shield of ca told her that they did not need that information. That she qualified based on her BMI alone. That it was a mandated procedure for blue shield if the patient's BMI is over 40 or 35 with co-morbidities. It took Blue shield one month to overturn Lakeside's decision. She now has her authorization to see Dr. Quilici and we will keep you all updated. Blue shield told her that basically once Dr. Quilici puts in authorization for the surgery, they will be "babysitting" lakeside throughout the process practially bullying them to approve it, since they overrode the medical group's decision.

You need to stay on the insurance companies. Who cares if they know your name and practically expect you to call. "the squeaky wheel gets the oil", or so the saying goes.

She is 5'2" weight 252. no co-morbidities.