Blue Cross HMO - Calif - Approved

Hello. I learned today that I have been approved for laparoscopic banding from my HMO - Blue Cross, CA. I have been reading the posts for a few months and wanted to share my experience - 100% positive, with my BC HMO insurance program.  The actual time from the bariatric office submitting my case to Blue Cross to getting the official approval for surgery was 30 hours!   I also wanted to pass along a few strategies that were helpful in moving my case along. Time-line - approximately 3 1/2 months have passed since my initial referral meeting with my chosen bariatric surgeon (within Blue Cross) to my confirmed approval, today. I initiated the idea of lap-banding by requesting a referral from my Primary Care Physician in March. He was supportive, but not so involved beyond the official referral to the bariatric team. Once I was lined up with the BC "Center of Excellence" (Torrance Memorial Hospital bariatric team), I was skillfully directed and guided through an extremely comprehensive battery of tests and procedures. I did NOT have to enroll in a weight loss program for 3 or 6 months, but I was required to lose 10% of my body weight. Pre-surgery testing was very comprehensive. I lead a very active lifestyle; I am a healthy person (although "morbidly obese"). I am a 46 year old female with a starting BMI of 39. For me, testing required included: upper and lower GI, pulmonary function test, bone density scan, vein scan, chest x-ray, organ ultrasounds, sleep study (apnea found- a co-morbidity), psychological evaluation, nutritional couseling, support group attendance, barium swallow, EKG, blood panels and extensive labwork, and recent GYN - Mammogram exams. Each and every one of the procedures, scans, tests was immediately approved upon the surgeon's request and 100% covered. I was extremely impressed with the efficiency of Blue Cross throughout this entire process. I had a few $10 co-pays that I was happy to pay. The referral - approval process was seamless on my end. Be persistent. The sheer number of appointments can be overwhelming. I made the task of obtaining/attending appointments my number one, absolute priority throughout the last few months. I called several times in a day/week to snag cancellations (the bone density scan only had availability 3 months out and I got a cancellation appointment on my 4th day calling). I went to appointments before work, during my lunch, etc. and tried to be as accessible and flexible as possible - this was critical in moving the process along. I sometimes cleared 3 procedures a day by using a few hours off from work. Be kind. I was very pleasant with the appointment personnel, the office workers, and each and every person involved - in person or on the phone. This was extremely helpful - I'd guess it was even critical. I could hear the fingers clicking away on a computer keyboard as the clerk searched and searched for availability on appointments. More often than not  they were successful, despite being a bit pessimistic when I'd first encounter them on the phone. Be prepared. Request and keep copies of all of your testing. I carried a binder at first, then upgraded to an accordian file to carry all previous testing, referrals, approvals, etc. with me from appointment to appointment. It was extremely useful a few times when one office needed the results from another office and the fax hadn't arrived or had been misplaced. I simply pulled out the results to share with the specialist and we were able to quickly proceed. I think this also earned some respect from some offices. Follow-directions. My surgeon asked me to lose 24 lbs - and I did it. It was not pleasant. It was grueling - but I knew it was possible. How many times have each and every one of us lost 24 lbs? My latest pre-surgery appointment with the surgeon was last week. She clearly found the weight loss to be a indicator that I was willing and ready for this life-changing tool. I watched her note in my chart that I was a "very good candidate" for the lap band surgery. I hope any part of my shared experiences will help ANY ONE in ANY WAY. Good luck with your insurance "journey" - just wanted to pass along info and tips. Surgery scheduled for later this month - I will be getting the newer Allergan AP band with the smaller port. So very excited. ; ) Cathy

Congrats Cathy! I am happy for you.  I am in the waiting boat of hearing from the insurance company.  My paperwork was sent in on May 29th.  So hopefully, I will be hearing something soon.

Sharon...the best to you with your pendign approval ; )  Let me know if it all goes through.  Just found out my surgery is at leat a week delayed...still looking forward to whatever new dsate they now chose.   Soon to be bandster, Cathy

Thank you so much. I too began the grueling process with everything. Then changed jobs and lost the benefit with my new job. I was so upset, I threw everything away and now today I am working (again) for the same company and have to start over. I am determined and your information made me remember why I want to.  Thanks