Ellisa

Who knows. I have Anthem BC/BS of Ohio. Mine was sent in 6 weeks ago. For 4 weeks they claimed they didn't have anything. But the doc's office had a confirmation that they did. Then I got a "pended" letter which from the looks of what they were requesting someone must have lost half of my paperwork. That was faxed again last week, and now I'm still getting that nothing has been received. I can't get past customer service. Every time I'm transferred all I get is a voicemail and on one ever return my calls. Even the doc's office is getting the same "loop." Some people seem to get approvals within 2 weeks. My experience with othe claims has been hastle after hastle. Surely it's just a coincidence, but it's been very frustrating. From what I can gather, there is a national BC/BS office that handles pre determinations. I don't think the state or "brand" makes that much difference, but your individual policy does. But then, I could be wrong. It certainly is shrouded in mystery.

Snowbird, How does that work? You pay upfront and then wait to be reimbursed? What are your chances they will pay after the fact? Ellisa

Well, doc's office re-faxed the stuff to Anthem today. We'll see what happens.

The word I'm getting from my doc's office is that they think that there may be some missing paperwork. They were going to try to get to the bottom of it today, but I didn't hear anything. Again, thanks for listening.

Well, pay no attention to the woman behind the curtain (that'd be me). Little do I know about what insurance companies want. I was denied by Anthem yesterday. The doc's office is floored, they can't imagine why. Well I guess I can imagine... because they CAN.

Yes I will appeal. But it's just so frustrating that they can jerk people around like this. They read me a list of reasons, and all I could think was, "did they lose half of the paperwork that was faxed to them?" But I was too upset at the moment to deal with it. When I get the letter (which was mailed today) I can give you the specifics. Thanks for the support!

I finally got word from Anthem BC/BS... I was denied. They gave a whole list of reasons. I'm floored. The insurance person at my Doc's office assured me that all of the i's were dotted and the t's crossed and she saw no reason it should be denied. Well I guess you live and learn. After spending the cost of the consultation plus $300 "program fee" the only thing getting lighter is my wallet.

Dustout, I called Anthem yesterday and they said my claim was "in the sytem" and "pending." I should hear something by Friday. I'm not holding my breath, but I'm a little optimistic about it.

Thanks for the encouragement. I'll wait until Thursday and call again. I only call once a week, I don't think that's being too pesky.

As I understand they will accept documentation of your weight from any physician. But you must have the last consecutive 5 years. I do know someone personally who was able to submit photos due to lost medical records. But the photos had to be dated.

I feel your pain. If we were substance abusers I doubt they would make us wait forever. It's discrimination and it isn't fair. I'm waiting for pre determination. It's been sitting in their office for 4 weeks and they are too busy to even look at it or enter it into their database so that their own customer service department can see that it's there. ARRRRRRRRR

Another week and still no response from Athem. They continue to be "too busy" to even enter my paperwork in their database. It will be 4 weeks on Monday since it was faxed to them. I just think that's totally rediculous for them to leave it in a pile untouched for 4 weeks. Any ideas? I can't get past customer service, who are very nice but as useless as utters on a bull (that's the polite version of one of my Dad's old sayings). They've left messages for "pre determination" but they are too busy to return calls. I only call once a week.

I can't answer that for certain, usually employees with group policies don't have to worry about pre-existing issues. I also was shocked to find out that my DH was denied recently for life insurance because of having lap band surgery! I would think it would be better to have the surgery than to be obese, but then, the probably would have denied him for that as well.

I'm having a terrible horrible very bad day. I called my insurance co. last week and they said they hadn't received anything although my doc's office said it was sent in the week before. So I called back today and again the ins. said they hadn't received anything. So the doc's office called them and they said yes they had it but they were so far behind they hadn't had a chance to look at it. Over two weeks and they don't have time to look at it and even update their database that they have it? What kind of crap is that? ARRRRRRRRRR

KatieP, Most of the time insurance through employers don't have an issue with pre existing conditions. But companies can choose to exclude bariatric surgery on their individual policy. In other words, one person's employer may have Anthem and cover the surgery, the business next door might have an exclusion. It's less expensive. Smaller companies are more apt to have the exclusion. Call the number on the back of your card and ask the customer service representative.

Glad to hear it went as well as it did. I'll watch for your posts on other forums now that you're in the "big league;" quickly becoming one of the lean, but not mean. I also have issues with nausea following surgery. No, it's not just nausea... I usually toss my Cookies for a few days. So yes, I will make sure they know going in. I have a way to go, my stuff just went to insurance last week.

The program fee was $300. It includes the cost of the office submitting required paperwork to the insurance company and one appeal, if necessary, with an attorney. I've heard most places are charging program fees now. It is a little reassuring that there's someone to make sure the i's are dotted and t's crossed before it goes in. I was denied a few years ago, and really never knew exactly why. Right at the time I couldn't deal with an appeal because one of my parents had just be diagnosed with a terminal illness. At least I feel like this time, at the very least I'll have some answers. I also had to have a psych eval, which insurance might cover. Then there's the suppliments for the 10 day diet and the cost of the dietician. It's the 12th! Your day is coming quickly!

Dustout, Oh my it's the 11th already. You are just a few days away! Your posts are so encouraging. You seem to have so much in common with my insurance issues. The office manager at my doc's office seemed optimistic and she's supposed to know these things... but there's this little piece of me that wonders... what if they tell everyone that just to get the "program fee?" Isn't that just horrible of me? I think it's the result of being denied 4 years ago (Med Mutual then) after believing it was going to be approved (different facility, too). I want to believe, but... Please post as soon as you can afterward, I'll be looking forward to hearing about how you get along. Donna

Thanks for the information. I had actually called my insurance company before starting the process and was told (it seemed somewhat grudgingly) that it was covered. IF if was "medically necessary." But not what specifically was required to be medically necessary. They weren't particularly easy to talk to. The surgeon's office seemed to think I met the qualifications on my BMI. But I keep hearing that sometimes they want X number of years of medical records or X number of months on a physician supervised diet plan. So it was really nice to see the policy. It would have been so nice if they would have simply referred me to that.

Below is a quote and link from "Dustout." (I copied and pasted one of her responses, hope that's not a bad thing.) She said that the policy is not state specific (I asked on another thread). The links is very informative. Ellisa "I have anthem. Here is the link to their official policy: http://www.anthem.com/medicalpolicie.../pw_034084.pdf 35-39 BMI requires 2 comorbidities. 40+ BMI does _NOT_ require any comorbidities. I was approved a month ago one comorbidity (hypertension) although it's being easily treated with dieretic. Good luck and check out that policy!"

Congratulations. I know you must be so excited. Was there an exclusion on your policy or just that the company was being picky?

Thanks for the information. The site is informative. I'm hoping I don't have to do the 6 months supervised weightloss. I too have a long history, but most of it not physician documented. Seven years worth of my medical records are MIA. ARRRRR Happened when my doc changed practices, he didn't take them but the former place claimed he did. Regardless, I don't have them. During that time I was using Merida and Redux. Please keep in touch so I'll know how things go for you. I know you must be so excited you can't sleep! My husband was banded two years ago. I can't tell you what a difference it has made for him. He used to be so tired all the time, now I can't keep up with him.

Congratulations! The 15th! Wow! Which state is your policy with? I have Anthem PPO, with Ohio. I was told by my surgeon's office to allow 4 - 6 weeks for approval, it was sent in this week. My surgeon is already booked through the end of November so it will be after the first of the year at the earliest. I had hoped for sooner, but hey. Again congrats to you!

Congrats! Which state is your Anthem policy? I'm with Anthem of Ohio. Six months seems excessive. I just had my paperwork submitted this week and was told 4 - 6 weeks. My initial consult was the 3rd week of September. But if it has to be 6 months, I guess it's better than never. Again, congratulatons on your approval and hope all goes well for you.

Is the Anthem link for all states? I couldn't tell from the link if it was state specific. Thanks for posting it regardless, it is extremely informative.