Anyone had Blue Shield HMO?? - ThinnerTimes - Gastric Bypass Forum, Lap Band Forum, and Vertical Sleeve Gastrectomy Forum

Melody · 11-08-2004, 02:28 PM

Hi Everyone,

Well its open enrollment for benefits and I am pondering whether or not to switch insurances. I was denied by Cigna PPO for the surgery and told that I needed to do a 6 month medically supervised weight program. My company also offers Blue Shield HMO and Pacificare. I was wondering if anyone has dealt with either one of them. A coworker told me that she thought the requirements for Blue shield were more lenient. The only thing that keeps me from going with an HMO is that you have to get a referral for everything. Anyone got any advice on this? I'd appreciate it.

Melody
(pre-op.. still trying to figure out what to do)

MaryClipper · 11-08-2004, 02:46 PM

I have Pacificare HMO and had no problem getting through the approval process. I am with Sharp Community Medical Group. They also require a six-month supervised diet. I think they all require that now. I doubt that you will be able to get around that, but if you get started six months will be gone before you know it.

Good Luck

Christina · 11-08-2004, 03:31 PM

I had Blue Shield HMO when I got my surgery. I had no problems with it. I got approved for my consult in 2 days and my surgery in 2 days. No hastles. They ALL require a 6 month medically supervised diet.. which my friend with Blue Shield (at least when I had it) just meant that you had to be weighed in once a month and discuss your progress and/or failures with your Doctor. I was on Atkins prior to my surgery for about a year.. under the supervision of my PCP.. but didn't go every month to weigh in. I was acutally suprised at how easy it was to get through the process. Sometimes with the HMO's it is much easier.. give it a shot girlfriend. Just have your Dr. recommend Atkins, SouthBeach or an alternative diet and go in and weigh in every once in a while so that you can show you have been medically supervised with it. Just start now!!! That way you are well on your way.. plus I don't know if you saw the letter I submitted on an earlier post by Kelley but that is what got me approved right away for my consult.. just try it.. heck it couldn't hurt.

Good luck girlfriend.. I know you've been dealing with this for a long time.. let me know if there is ANYTHING I can do to help.. I am more than happy to do so.

fairydust · 11-08-2004, 06:06 PM

I have an HMO as well, and I had to obtain referrals.. I have to attend a six month pre-op clinic..I am in month three pre-op now, once a month, I see one doctor or another, attend support groups, next it is my phyiscal, then psych eval...and hopefully i will get a green light...

Blueyz · 11-08-2004, 09:19 PM

I have Blue Shield HMO and was denied the first round. I appealed and was approved. It took some fighting, but every day of fighting was well worth the wait. Good luck.

alex · 11-09-2004, 01:28 AM

Hi Melody!
Having An Hmo Is Not That Bad, I Have Blue Shield Hmo And My Surgery Was Approved In 2 Days. If You Don't Have A Problem With Waiting Around For A Few Days For An Authorization (there Will Be Times When You Won't Need An Auth) Go For It! I Wish You The Best In Whatever You Decide To Do. Keep Us Posted.
Alejandra

Phebius · 11-09-2004, 09:39 PM

Hello Melody...I have Blue Shield HMO and I was denied twice. The first time I didn't fight it, but the second time around (about a year later), I appealed and won. I was able to submit my Jenny Craig records and the fact I had been referred to a nutritionist at one time.

A six month supervised diet seems to be the prerequisite (sp?) these days no matter which insurance you have. The PPOs just seem to process faster in my opinion based on some of the posts I've read. Have you been on a 6 month supervised diet?

One of my girlfriends had Pacificare and was approved, but I'm not sure of her circumstances or what kind of process she had to go through at the time...it was almost 6 years ago but her surgery was done by Dr. Callery.

Did you appeal with Cigna...what happened? I don't know how much time you have to decide if you want to change insurances, but you should definitely appeal with Cigna, especially if you're happy with your current PCP.

I don't think HMOs are that bad, I've never had a problem getting a referral or approval for anything other than the WLS, but then again, that's about a $30,000.00 request. I fought and won though...it's all about persistance and trying to take everything in stride as you go through this process. It's overwhelming and sometimes you just want to pull your hair out, but it is so worth it in the end.

Well, I hope this helps a little bit and I wish you nothing but success!

Americanwoman397 · 11-10-2004, 08:05 AM

I have Blue Cross HMO with Sharp. My pcp had to request a referral for my consult with Dr. Potts. I got my referral for the consult back in 4 days and my referral for surgery back in 2 days. I had a letter in my hand before the office got there letter.

Melody · 11-10-2004, 09:42 AM

Thank you everyone for your feedback on this. Pacificare is also another insurance option they offer. I'm still not sure what to do. I am going to call and talk to Leslie and see what she suggests as well. Thanks again for all of your continued help everyone! :-)

Melody

Christina · 11-10-2004, 09:48 AM

They both pay for the proceedure.. however, both require a 6 month medically supervised diet.

The best option for you is to check into the medical groups.. since with an HMO the Medical Group is who decides your fate, not the Insurance company itself.

Good luck to you!!! I miss you girl...