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Anthem BC/BS of Ohio PPO for Verizon Retirees - HELP!



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Good Morning,

Has anyone had any experience with BC/BS of Ohio PPO for Verizon Retirees? I was recently denied by them on the basis that I need a BMI of 40 or greater (mine is 36). Anthem only administers this self insured plan for Verizon. However, all the access materials to the benefits say a BMI of 35 to 39 is OK with comorbidities (sp?) which I have. I now have a Verizon Benefits Advocate helping me to get the actual benefit in writing but it's taking forever! BTW, an E-mail I sent from the "Anthem for Verizon website" in 2/2010 to verify my benefit was responded to me as needing a BMI of 35-39 w/comorbidities or 40+ w/o any so I was given wrong info to begin with. I faxed them a copy of the reply and they still denied me. This is a new health plan for us as of 1/1/2010 and I get the feeling that I'm the first Verizon retiree seeking approval for LAP-BAND®! Anthem claims it was my responsibility to verify my benefits with Verizon and that it is on Verizon's website. Not there...Verizon's website says to call the member # on the back of my ins card which I also did 4 times and always got the same answer of OK for the BMI 35-39, etc. Anthem says Verizon chose this exclusion from Anthem's normal contract regarding bariatric surgery. Please, can I get your inputs about how I should handle this and do you think I need an attorney?

Priscilla

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