XPost: My experience with BCBS HMO CA in Central Valley
Just letting everyone know this has been my experience. YEAH Finally got to see Dr. Boone - Wooh Hoo
With BCBS HMO and Sante' Medical group we found that since May 2007 we had to:
1) Get a referral from PCP to an approved weight mgmnt clinic for 6 month medical supervised diet with psych, nutrition and physical therapist (I got the name from BCBS directly so I knew where they wanted me to go)
2) Complete the 6 months
3) Do blood work, psych & physical exams/clearances (may include EKG/Cardiac clearance, pap & mammogram, PSA/colonoscopy etc... depending on age, sex & health of individual)
4) attend surgeons presentation (I actually did this at start, DH at finish)
5) Get wt mgmnt to submit request to Sante' for referral to Surgeon for consult (DH is here)
6) Meet with surgeon and have his office submit request for surgery (I am here)
7) Complete surgeon's requirements if any
8) HAVE SURGERY
We started this process in May of last year and I just saw the surgeon yesterday. My DH was denied at #5 because Sante' requires you to meet all requirements for surgery before they'll even let you have a consult. Surgeons office wouldn't see us either until we were approved. DH has a BMI of 36 & weight management didn't ask for or send any of the info regarding his diabetes & sleep apnea. Once we had his old records forwarded it was immediately approved.
I'll post this in a couple of places because things change and ppl who went through this process even 2 yrs ago have had different experiences. Possible other physicians groups do things differently but in the Central Valley there is only 1 option and this is it.
Please remember that as of today I have met the surgeon once & have not been approved. If there are any changes to above I will update you.
Let me know if anyone has had different process here in Valley or with other groups in state.
DJ
With BCBS HMO and Sante' Medical group we found that since May 2007 we had to:
1) Get a referral from PCP to an approved weight mgmnt clinic for 6 month medical supervised diet with psych, nutrition and physical therapist (I got the name from BCBS directly so I knew where they wanted me to go)
2) Complete the 6 months
3) Do blood work, psych & physical exams/clearances (may include EKG/Cardiac clearance, pap & mammogram, PSA/colonoscopy etc... depending on age, sex & health of individual)
4) attend surgeons presentation (I actually did this at start, DH at finish)
5) Get wt mgmnt to submit request to Sante' for referral to Surgeon for consult (DH is here)
6) Meet with surgeon and have his office submit request for surgery (I am here)
7) Complete surgeon's requirements if any
8) HAVE SURGERY
We started this process in May of last year and I just saw the surgeon yesterday. My DH was denied at #5 because Sante' requires you to meet all requirements for surgery before they'll even let you have a consult. Surgeons office wouldn't see us either until we were approved. DH has a BMI of 36 & weight management didn't ask for or send any of the info regarding his diabetes & sleep apnea. Once we had his old records forwarded it was immediately approved.
I'll post this in a couple of places because things change and ppl who went through this process even 2 yrs ago have had different experiences. Possible other physicians groups do things differently but in the Central Valley there is only 1 option and this is it.
Please remember that as of today I have met the surgeon once & have not been approved. If there are any changes to above I will update you.
Let me know if anyone has had different process here in Valley or with other groups in state.
DJ
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