Health Net or Blue Cross in Cali???

I'm in a unique position. My business is providing a group insurance policy for our employees. I'm the owner, so I get to choose which policy we go with!

I'd like to pick a plan that doesn't hassle me with a 3-6 month supervised diet requirement or other hoops to jump through. Leaning toward Health Net or Blue Cross. Also leaning toward getting Lap Band surgery.

Which Insurance do you suggest???

A little background...

I'm 42 and have struggled with my weight since I was 12. Since then, I've rarely been at a healthy weight. In fact, I've been at an unhealthy weight for over ten years now. I've tried every diet imaginable, weight loss camps/spas, a psychological program called Dietless. Nothing has worked. The process has left me demoralized. The only hope I can see is through surgery.

Thanks,

Frank

I had BLue Cross PPO, but I have heard some people on here say they are not covering it, I think you will need to find out which insurance pays for it and then find out what their policy is to have surgery.  I know that Blue Cross and Health Net both have different policies within their network too.

Good luck, Diane

I have Blue Shield HMO with Access Plus option. Paid 100%. I thought BS and BC were the same.

Apparently in Cali, BC and BS are separate. My insurance is "BC of Cali" -- there isn't a "shield" anywhere in the name.

OP--I have a PPO w/BC, it was approved w/o issue.

There is another posted on the Cali boards named Melissa. She's pre-op and I think she said she has Health Net and that they required a 6 month pre-op diet.

Hope this helps.

Hi Frank,
I have Blue Cross PPO and they were terrific. I know of two others who sailed right thru with Blue Cross too, one before me and one last July. Our sureon requires a physician's assistant that BC doesn't pay for, but they tell us that upfront; we each had to pay 2500 dollars for that but they covered everything else. I would check with the doctor you are planning on using; he/she can probably tell you who they like best.
Good luck choosing,
nancy

Frank, I think you will need to read the specifics of the policies available to your business. Some policies have exclusions for small businesses or groups, meaning that the policy won't cover wls of any kind. These exclusions are impossible to fight. So knowing that it's through, just for example, Health Net, doesn't tell the story. Read the specifics for your potential group plan.
    Also if wls is covered, check on which operations are covered. Some plans don't cover every procedure. That's easier to fight than an exclusion but still no picnic.

Larra

I think, and I could be wrong, but the difference between whether or not your insurance will require you to have the 6-month diet or not, is the difference between the PPO and the HMO...or so I was told...not sure if that's right, though.

I have Health Net HMO and I had to do the 6 month diet.  However, I was told by Health Net that it wasn't them requiring the diet, but it was my primary care physician's MEDICAL GROUP *****quired the 6 month diet.  Once I had that out of the way and got the okay from the stupid medical group, Health Net HMO approved my request for surgery within a week.

Thanks for the info. It's very helpful!

BTW... I talked with the Insurance coordinator at my doctor's office today. She says both Blue Cross PPO and Health Net PPO are the same. Both offer coverage w/out having to jump through the supervised diet or other loops.

After reading the responses to another post I submitted I see I've still got a lot of homework to do. It took me three months to choose my Doctor, looks like I'm settled on my Insurance, but now I have some research to do about the procedure I will have. Was thinking Lap Band, but now... ???

Thanks again,

Frank

 I have Health Net HMO through my husband's employer. They do not have a WLS exclusion. Health Net and my Medical Group required a six month diet but in the state of CA, if you have a HMO and your insurance is from a CA based company you can contact the CA Dept. of Managed Health Care (DMHC) to bypass the 6 month supervised diet.

Like Larra said you really have to look at the specifics of the policies that are being offered to you. Some exclude WLS no matter what, some cover some procedures and not others. You ultimately have the power since you are the one buying the policy. 

Have you looked into the DS? Make sure you research all your options and visit all the various surgery forums.

I have Helathnet HMO in the Bay Area.  I got my surgeons appt. under a week from when my pcp requested it. My first appt was on August 21, 2008.  I have no other medical problems, just obesity.  I got my list of tests to do preop and the surgeon also required me to lose 5-10% of  my body weight before they would schedule my surgery.  I got all my preop tests done in Sept.  Saw my surgeon the 3rd week in October and had surgery 11-25-08.  Healthnet told me that as lond as I do what the surgeon requires, that they would approve my surgery and they did.  So from start to surgery was only 3 months, I I thought it was a long time, how naive I was.

Good luck and know it will happen when it is meant to happen.  Look forward to seeing you on the loser's side!