BlueShield HMO (CalPers) questions about insurance plz

Hello, I am a California State employee and have Blueshield HMO from CalPers.  I was told I had to complete a 6th month medically supervised weight loss program.  I wanted to know if anyone has had this insurance and got approved.  What other requirements will they require?  Does anyone have information on how I can get approval? I am 5'2, 255 lbs, High BP, evelated surgar, arthritis, gall bladder removed, severly fatty liver (what does that mean?), hysterectomy due to ovarian cancer and have had back and knee surgery.  Thank you for the help in advance.  God bless you all.

Hello my name is Nena and I have Blue Shield HMO and had my surgery 02-12-07. Luckily I had no problems with them I had a great surgeon. And because my primary physician was great a documenting all of my health issues my insurance approved it in no time. I had to obviously lose weight before the surgery and do the Psycological Evaluation, go to a nutritionist, etc. All was approved with no problems. It seems that you have all the same issues I did as well. One of the things my surgeon did request, was to do the sleep apnea testing. I had to do that a couple of times and of course it showed I had mild to moderate sleep apnea. When I started my process I weighed 257 and I am 5'3. As of today which I am just about 5 months shy since the surgery, I weigh 169 look and feel great!!! I look like a totally different person. My knees or feet do not hurt anymore my anxiety issues are gone. I wish you the best of luck and if you have anymore questions dont hesitate to ask.

Thank you for your response.  I would first like to congradulate you on your surgery and successes...good job!!!   Your reply is very hopeful for me.  I have to do this 6 month supervised diet before I can even start the referral process.  DID YOU HAVE TO DO THAT?  Anyway, I have in my second month of this program and have only lost 2 lbs.  I will try harder. Thank you for your response.  Have a great day. Val

I did not have to do that 6 mo. supervised diet. I guess I was really lucky because my insurance did not even question anything. Every insurance I guess is very different, but i seemed to have no trouble at all. One thing I really would suggest you do, is make sure you save all your approvals for any procedures or doctor you are given. I now am starting to see bills stemming from the surgery that the insurance has not paid. And luckily I saved all my paperwork so I just faxed over to them and they have to pay since they had pre-approved all the procedures!!! Good Luck and great job on the weight loss!!! Keep on keepin on, it;s hard but you can do it!!! :)

Hi! I also have Blue Shield Cal Pers HMO since my husband is a public employee.  My medical group is Community Medical Group of Thousand Oaks.  My primary doctor is Dr. Stanley Su in Thousand Oaks.  I recently got authorized to have a consultation at UCLA Medical Center with Dr. Amir Mehran.   I think it has a lot to do with who your medical group is and who they refer you to.  I know with UCLA, you have to have a "medically supervised" diet for 1 year or so.  But the rest is just routine, like co-morbidities and stuff like that.  Find out with your medical group who your surgeons will be and then contact them and get more information.  I also believe having a good primary care physician is key to your success. I am 5'3" and I weigh 221lbs with a BMI of 39.2.  I also have hypertension, I had my gall bladder removed, and a list of other co-morbidities.  I had my consultation approved and I went on last Monday July the 2nd.  And now I'm working on my pre-op requirements and if all goes well, I should be having surgery the first or second week of August.  Don't give up hope. Good Luck!

Thank you for your response.  I have Physcians Assoc.  as a medical group and they require a 6 month medically supervised weight loss program that I am in my second month of.  There have been no other approvals this far until I finish this program.   My primary doc isn't really on board with wls but she knows all of my issues and I am afraid to change now.   Did you finish that one year medically supervised diet?   Did you lose on it?  Congratulations on your weight loss and I wish you well with the rest of the process.   Thank you again for responding to my post.