insurance questions

[pattybeyster 0]

anyone had surgery under Anthem Blue Cross? I have been hearing that alot of insurance Co are making you do a medically supervised program for up to 6 months before they will approve the surgery. Does anyone know if this is the case for Anthem Blue Cross? I already did WW for almost 8 months and have verif of that but I don't think that is concidered medically supervised. Anyone?

[mispritsy 0]

Hello. I am going through all of this myself, plus i work for Anthem ( Yay me! lol) anyway, I of course have Anthem BCBS and yes the WW doesnt count. I had been on Adipex for over a year so that counts. I am waiting for my Psych eval to come back so they can submit everything so that my ball can start rolling!

[Manda87 3]

I have Empire Blue Cross and they don't require a diet. The only diet that is required is from my doctor which is a 2 week liquid diet.< /p>

[mispritsy 0]

Yea, i do the 2 week diet 2 weeks before i get surgery.

[special_01k 0]

I have bluecross Blueshield ppo and just need nutrition and psycological evaluations and that's it. Got approval in 3 days!!!!

[newdicarlo 0]

I have Anthem and they did not require the 6 month Dr approved diet. I submitted paperwork last January 3 and had approval in about 2 weeks.

[philippians413 0]

I have Anthem. I didn't have to do any supervised diet at all. Just a psych eval and nutrition consult. I was approved in less than a week. I think it somewhat depends on your particular plan thoughl

[mispritsy 0]

Yes, it depends on your insurance ( I have Anthem HRA), your plan, you BMI (which mine is only just above 40), and if you are under 40 BMI they need you to have some co-morbidities such as sleep apnea, hypertension, diabetes etc.

So i had my psych eval last wednesday Jan 6th, 2010, I had to have my doctor send in the past 2 yrs of medical hx, and I also had to have a medical "surgery" clearance form filled out.

As o today, I am waiting for my psych eval to come back whuch they say should be next week so that they can submit all of my above to Anthem. From there I am wondering how long would it take to get my approval.

[ParrotheadCathy 0]

There is diversity across ALL the policies issued by any single insurance company. It's based on what any given employer is willing to pay for! So one Anthem policy won't cover weight loss surgery at all, another will cover it with the supervised and diet and another will cover it with a required minimum BMI for a specified period of time, etc.

The only way to know what your policy covers and how is either read the booklet if you have one or call. There is a customer service phone number on your insurance card. Call them. They will need your policy number. Ask:

1. If your policy will pay for lap banding (some will cover gastric bypass but not banding so be specific).

2. What their requirements are for you to qualify. Some possibibilities are a minimum BMI of one number and perhaps a different number if you have 1 or 2 comorbidities. So, say a BMI of 37 with 2 comorbidities or a BMI of 40 or higher might be possible answers.

3. What surgeons in your area are on you policy.

4. Whether or not they have a requirement that the surgeon use a specific surgical center (I've read where some require the surgeon to use a "Center of Excellence"), or if they require an overnight stay. If they require an overnight stay, verify what hospitals are on your plan.

5. Ask if they require a supervised diet. If yes, then ask does Weight Watchers qualify or must it be doctor supervised. If it must be doctor supervised, ask if your primary caredoc can supervise or if the lap band surgeon's office can do it.

6. Finally, ask anything else you can think of. I've recently read on here where a couple of people discovered their insurance would pay for the surgery BUT NOT THEIR FILLS. Ask! And if they don'to cover fills, when you are interviewing surgeons, ask what their charge is for fills not covered by insurance (for example, mine charges $125). And ask the surgeon how many fills are included in the price of surgery (for example, mine included one year of follow-ups and all the fills and any unfills that would be done in that time period).

Good luck!

[mispritsy 0]

Thanks for summing that up! That's pretty much it in a nutshell. I too work for Anthem Wellpoint so the plan I chose over what my coworker that sits right next to me are different plans. Her plan doesnt cover lapband and mine does. So great explanation Cathy!

[Becky Lou 0]

Have you been approved yet? I have Empire PPO and am sending my stuff in this week. Then I will be doing the waiting game. If you have been approved how long did it take? I'm just so nervous. It sounds like we have the same policy. They only thing I need is a Physc eval and the Dr. saying I have been dieting in the past and it needs to be medically Necessary.

[mispritsy 0]

Becky Lou, I have not been approved yet. The office called me yesterday to tell me that my insurance does cover my band ( as if I didnt know that.....I work for Anthem) and with that said, I do not have Empire. I have Anthem HRA. I think the most I might pay out of pocket is for my Medifast for two weeks and $300 for the band.

I am still waiting for my Psych Eval to come back, once that comes back (which it should be in no later than next Monday), they will submit everything. I already did a supervised diet (Adipex) for over a year before I even considered the Band. However, when the office called me to let me know my insurance covered the Band, they also mentioned I didnt need to have a supervised diet with the plan that I have.

Let me know when you get approved. :thumbup: