BCBS of CA - Out of state insurance

Anyone have BCBS of CA (now Anthem) but reside in a state other than CA? If so were you required to have 6 months documented non-surgical weight loss attempts? I went to my first appointment today (been waiting since January), only to be told since I have "out of state insurance" (I live in North Carolina and my insurance BCBS of CA)  I would have to have the documentation.  ~Jennifer

This sounds bogus to me.  BC of CA (I dont think BCBS of CA exists, out here they are seperate) does not specifically require a 6 month diet.  If your BC of Ca policy covers WLS the general guidelines are contained in this document.   http://www.bluecrossca.com/medicalpolicies/policies/mp_pw_a0 53317.htm If your BC policy is an HMO type, the HMO (IPA or PMG) guidelines will likely be imposed.  Hope that helps - D2K

We deal with this all the time....a patient will say, "I have BCBS of IL (we live in TN now) but all my claims are processed through BCBS TN so I have to follow TN's rules" and that is not true. You have to follow the rules of your insurer, not your local plan. If your insurer says 6 month MSD, you need to do it. I have had 2 BCBS CA patients from United Rental (their employer) who got approved without a MSD. SO call your insurer and ask for utilization management or precertifications, one of those 2 departments will be able to get you the criteria for your specific policy. If your surgeon's office cannot help, come over to mine in Knoxville and we'll help you! Bonnie RNY 6/3/05

Thanks everyone for your advice! I called the insurance company's customer service and got the run-around so I called the utilization management department as Bonnie suggested and found someone willing to help. She is sending me the criteria that need to be met for bariatric surgery. The biggest roadblock on this jouney is trying to determine what the insurance company requires. When I first started the process, I called and was never told I would need the 6 month MSD. I'll keep you posted. Thanks again! ~Jennifer