BCBS California -no timeline?!? (and a few more Q's)

Hello everyone, this is my first post here but I've been posting over in the VSG forum. I've gotten some great advice and now Kahlua has sent me over to hear to see if maybe you guys can help me even more. Like I said, I'm going for the gastric sleeve which we found out will be covered by BCBS California if we prove its a medical necessity. The long story short is that I only have until April to get approved because then my insurance changes. I heard this information from the program coordinator at my surgeon's office. She said they had said that they required a record of an organized weight loss program, using Jenny Craig as an example but said they made no mention to needing an exercise history / record of exercise / diet history. The first time I called and the person I talked to actually brought up my plan they also said "there is no timeline besides your surgeon's timeline." Does this seem normal to you guys? I feel like it's too good to be true and there must be catches... Am I wrong to be so dubious? Still, we plan for my PCP to send a letter documenting my weight the past year (since it's recorded when I go into his office every month) and speaking of my diet (since he knows I only eat VERY healthy foods).  My doctor will also of course say that I'm a good candidate for this surgery (healthy enough to have surgery, BMI over 40) and though I have no other health problems caused by being obese, the conditions I do have will be greatly improved for my genetic blood condition. (And that someday, my obesity mixed with my tiring health condition will obviously lead to more health problems too). What do you guys think? Any idea whether this will be enough? We'll also of course include nutritionist visit, the required tests, , the psych evaluation, etc. I'm just really stressed now since I only have a month before I'll change insurances and have to self-pay. It's my one shot at having insurance cover it but I want to know if I ever stand a chance with only having a month left and if BCBS of California won't let me down. Will they even respond in that short amount of time if I send the package in two weeks? Thanks ahead of time for any replies. Nia

whn your insurance chnages will it no longer be a covered benefit of the plan? I have bcbs/il. they want to see your weight for 6 months straight. do they have other requirements such as a psych eval and things like that? i have a great chart that you can use to fill out the 6 month diet. pm me if you wants me to send it to you. fill it out to correspond w/ each month's visit. the submit if you have done everything else. have the surg. office fax it not mail it. also if you have already started the wls process the new plan may cover it since you have already started the steps. what do you mean by a "timeline"? pm me so I can try and help you.

My new insurance will not cover the gastric sleeve, or weight loss surgery 80% and has MUCH stricter guidelines. So it's either I get approved for surgery in April or self - pay this summer. Either they take all that I can get together in the next couple weeks (which won't be a detailed six month diet besides the last six weights for the last six months from my doctor AND EGD psych eval, nutritionist, cbc),  or we self - pay. Good idea on the faxing! Maybe now that you have more information you can help me but maybe not. I hope someone is around who has BCBS of California like me! Thanks for the reply,  Nia

Nia the following link is the medical policy of your insurance company http://www.bluecrossca.com/medicalpolicies/policies/mp_pw_a0 53317.htm

Thank you Thank you Thank you! I'm going to over this with my family right now!!!! Nia

Oh -actually would you mind telling me how you got there (to the page which shows the policy).  I have PPO, not HMO and at the bottom it says applicable to Commercial HMO members in California. Is it different? I asked my mother and she thinks so......

Thanks,

Nia

The link I gave you comes off the Provider access screens I can copy the link for you like I did but you cant get into it cause its secured website for providers.  The medical policy is universal for all HMO PPO and Loumenous products for CA Blue Cross but that is the policy

I have BCBS CA and they use the same medical policy.   its a univesal medical policy for all BCBS CA  only difference is the provider then has to go the the individual's policy to see what type benefits and payment would be made by BC Hope this helps  VIcki

Oh okay, I have think I have it all figured now. Thanks for the explanation, I have so much more clarity now! I made some notes after reading the policy and I'm going to call my doctors Monday. Thanks for all the help! Nia