Switch to Blue Cross of CA From So Cal Kaiser? DS Approval

Remember my friend we are trying to get him the DS .. he has Kaiser southern CA.

He now has the option of changing his insurance to Blue Cross of CA

Is Blue Cross insurance (southern CA) more friendly than Kaiser for the DS

thanks for any infor

Loretta

It depends on the policy.

Just FYI:

1) The "good" news is that SoCal Kaiser now has a DS surgeon on staff (Belzberg).  He's not vetted, but he's done them.

2) The bad news?
    a) You STILL have to appeal to the DMHC to force SoCal Kaiser to give you a DS
    b) You're stuck with a non-vetted surgeon (ACK!) with little or no appropriate aftercare (Sad, but common), who didn't want to give you a DS in the first place (should make for a GREAT surgeon-patient relationship)  Always remember to get your advise HERE instead.

3) The good news? He can change to BC of CA, which are less assholic about the DS, and that should give you a choice to use Keshishian.

4) The bad news? Keshishian has a substantial program fee (out of pocket expense) that is unlikely to cover anything you will need or be able to use.

no one can answer this question as the specific adhesion contract would have to be read, it really has nothing to do with Kaiser or BC but the specific wording, even within the same BC there are a multitude of different coverage levels, exclusions etc

Loretta, all insurances cover DS however it is up to the employer if they purchase the DS coverage.   When employers are choosing a plan for their employees they are given a menu of sorts, they balance costs vs usage in order to select the benefit they can afford to offer.  

The key would be checking the actual plan the employer is offering to see if it is covered and at what levels.  

Good luck

"Loretta, all insurances cover DS"

You don't know WTF you are talking about - once again.  Exhibit A = Kaiser.

Diana thanks SO much ..

Now that he has this chance to switch to Blue Cross, I had remembered from reading here on OH that Blue Cross was more DS friendly but wanted to check again before I said anything (cuz I wasn't sure)

This is exciting

The program fee won't  be an issue .. in this case.  I can't remember but I know it was some thousands for the program fee. If it's 5 grand or whatever it is out of pocket .. that is better than 40 + K $ worth of DS surgery that isn't covered.  I think he could handle paying the program fee.

What I hear you saying is that Blue Cross will cover the DS but not Dr. K's program fee?

Still if the DS part was covered by the insurance, And he could get the surgery by dr K , stay local, and have the follow up which I know is *get these labs and I will look at them*

It's more than that really in my eyes because if he gets a seroma, or a leak or what have you. He has the DS surgeon who can fix him close to home

I will have him get me a copy of the Blue Cross that he is considering and I will look at what it specifically says about DS

I wonder how FAST he could get his DS if starting over with Blue Cross of CA.  He was aiming for having it this summer, while he is off track (he is a Teacher)

He has tons of co morbidities and qualifying won't be an issue in that regard.

he Needs this health wise to be sooner than later

Does Blue Cross deny first and then make you appeal? Is there a go straight to Dr. K track? LOL

that would be ideal, but as long as he can get the DS by Blue Cross then I think maybe he should go that way



It must be his Open Enrollment period for insurance at his work

thanks again

Loretta

Diana

If he has a choice should he get Blue Cross CA HMO  or should he get Blue Cross CA PPO ?

thanks

Not Diana, but a BC "member."  With the PPO, you can just pick up the phone and make an appointment with, say, Keshishian, if he's in network.  (I'd call and check...he WAS may still be.)

With the HMO, you are stuck with your IPA...the group that you select when you choose which PCP you want.  That is, your primary is going to refer you to whoever does the bariatric surgery for YOUR LOCAL IPA, the one that s/he is a member of.

It will take FOREVER to fight your way out of that network and to a real DS surgeon.

sounds like ppo is the way to go, will investigate this further

thanks