Blue Shield HMO

I am new to this website and new to the whole WLS world.  I am curious if anyone had or has Blue Shield HMO and how long it took for the Insurance Co. to approve you once your PCP submitted the request?

Welcome to OH and to the Cali Board, it's nice to have you join us.  I have Blue Shield HMO and I began my journey in July.  The way it works, is your PCP submits the request and you get approval for a consult, which I had at UCSF.  My PCP submitted it in Oct. and my 1st surgical appointment was in Nov.  Then your surgeon may request pre-op tests, which need to be completed.  Once those are done, you will see the surgeon again and if all is right, they will schedule the surgery. 

In my case, I tried to have surgery in Concord, but Blue Shield will only allow the surgery to be done at UCSF or Stanford in the Bay Area.  I had considered self paying the surgical fee but Blue Shield would only pay for the hospital if they also paid for the surgeon.  Crazy to me, but that's what they wanted.  So, when I still thought I was going to self-pay, that surgeon requested the following tests:

Endoscopy (I also had my colonoscopy at the same time), cardiology clearance (which the cardiologist ordered a nuclear stress test), pulmonology clearance (pulmonologist ordered a pulmonary functional capacity eval).  All tests were normal and I went to UCSF and he was thrilled that all my tests were done and said I was good to go.  This was in Nov and they would have scheduled me on Dec. 18th but I told them no, to wait until after New Years. 

So, all in all it was a fairly quick process.  It also might depend on the Network you belong to, I belong to John Muir.  If you wish, you can read my blog for a complete timeline.

I hope this helped.  I wish you the best of luck on your journey, I am feeling wonderful and doing great and love my RNY!

Barb

Hi Barb and thank you for the nice welcome and your reply.  I am happy to hear you are doing great, that is always very encouraging.  Your information is very helpful.  The timeframe was indeed very quick.  My network is actually really great.  It is Cedars Sinai in Los Angeles.  I am sure there will be plenty of pre op things for me to have to complete.  I had a colonoscopy a couple of years ago so hopefully I won't have to revisit that adventure.   I just had knee surgery on December 8th for a torn maniscus and went through all the pre op for that with flying colors so I would think everything will be ok.  Continued great success and thank you again for the reply.

Hey, I hope your knee is doing better.  My husband had both knees done 2 weeks apart for the same thing in 2002 and he is so happy he did, no problems since.  Perhaps they might even be able to use some of the same results of the pre-ops they did for your knee.  It never hurts to ask!

You are very welcome and so glad you've joined us.  There are such wonderful people on the Cali board, very helpful and supportive, kind of like extended family, it's so nice.

Barb