At The Beginning

I'm At the beginning of my journey. Just called the insurance co. and found out I have to go to UC Davis and see Dr. Fuller or Dr. Ali.  Anyone here have any experience with getting approval with Blue Cross HMO using this hospital?  What requirements do they have?  My insurance says it's approval is on a case by case basis and would not tell me the requirements to qualify.  Grrrrrrrrr.. This is so frustrating!

Welcome! Some people on the boards here have used your Dr. Ali... I've seen his name...Muhammed Ali...hard to forget! LOL...

Just take it all one day at a time...get your insurance to be very clear with you about what they require, and then, just start checking off the pre-reqs!

Before you know it, you'll be all on your way....

Lori

Welcome to the CALI board.
I do not have answers for you but, I am certain someone will. If not today keep posting.
All the best to you on your weightloss journey,
Lynn

Thank you so much...This is so scary and it's nice to have someone there to talk to... Congrats on the Run!!! Kari

BC HMO, ugh! just switched from them, thank gawd! However, BC does not have much to do with it with how things will play out if you have the the HMO plan. If your policy was anything like mine, that is. Get a copy of your actual certificate to find out the details of our plan. Mine basically said that if the hmo doctor and the IPA or PMG said it was medically necessary, it would be covered. BUT! (big but) the doctor/PMG/IPA could have their own criteria for medical necessity. If you have determined which type of WLS you need/want and these guys do it and are good at it, then call the clinic office and ask which doctors/PMGs/IPAs have worked smoothly for them when patients have had your type of insurance plan. I found that my IPA/PMG (Hill Physicians) had a looooong, confusing and basically IMHO impossible (must 1) show reasonable compliance AND 2) fail a 6 month medically supervised diet) process that patients had to go through to even get a referral to have a consult with the clinic. Took me 6 months to even get an appointment to see the surgeon for the first time, and that was after they waived some of the 6 month diet garbage because I *****ed and moaned so very very much. I switched to the BC PPO and my surgeon's office submitted me for prior auth on monday, BC got it on tuesday and this morning, I was approved. I have truely felt your frustration. Find out from other patients which IPA you can switch to , if needed to smooth things out. My BC HMO plan allowed you to change anytime up to the 15th of each month and it would be effective the first of the next month. By the way, you can find BC of CA requirements for WLS at http://www.anthem.com/ca/medicalpolicies/policies/mp_pw_a053317.htm Good luck, and let me know if I can answer any other questions. d2k