Need Advise

I have Blue Shield of California PPO.  I asked them which bariatric surgeries they cover & what the requirements are & they haven't given me any information.  Does anyone have any suggestions about what questions to ask?  I know prior authorization is required.  Does that also mean before I even see a bariatric doctor?  Thank you. -Sarah

Prior auth is after you see the surgeon. You need to have documentation from the surgeon that you are a good candidate!  You also will need any other testing the surgeon recommends. A lso, there might be an insurance person at the surgeon who can help you.  Mainly, make sure it is covered by your insurer, then ask for pre-determinations, utilization management, pre-certification or care coordination (each insurer calls it something different) to find out specific requirements for your policy. Also try their website. I deal with BCBS of TN, IL and AL frequently and all the patients I have gotten approved have the same requirements, regardless of which employer the policy is through. But United healthcare is different for me in my job, the requirements vary by employer, so in that instance, the website is kind of useless since it gives generic requirements like a 6 month diet, although some employers do not require it. I wish I knew your insurer specifically to help you out! I hope what I did share helps and gives a few tips. Good luck! Bonnie