My experience with Anthem BCBS

[finallygettingthere 0]

I've spent the past few months researching and reviewing various forums regarding insurance for the lap-band. The main question I sought to answer was, "Do I need to have the six months supervised diet or whatever". I couldn't find an answer anywhere. What I did find was conflicting, and often ambigious. I even resorted to calling the insurance company to see what they had to say. Nothing. Oh, the insurance company had pleanty to say, but they didn't say anything. No one could find anything stating that I needed the supervised diet prior to authorization. My medical group even called the insurance, and they couldn't get an answer. I requested that when all of my paperwork was ready, that my medical group submit it in any case, and we'll see what would happen.

With the Anthem BCBS, I received a letter in the mail in about a week approving my lapband.

Now, which Anthem BCBS do I have? I don't know. There is nothing on my card stating where they're from, and I work in a different state then where I'm actually insured. I also live in a different state then either of those two, and am having the surgery in another state altogether!

Some questions I couldn't find answers to regarding insurance, and my answers:

Does Anthem BCBS cover lapbands? - Yes. Depends on your coverage as to how much they cover, and also it depends on where you have your lapband, in-network/out etc. I have the full blown PPO and it covers 90%.

Do they require the three/six-month supervised diet? - It was not required for my approval.

How do you find out if you got approved? - I read about people getting approved, but I didn't see how they knew. I received a letter in the mail from my insurance company.

How long does it take to hear from insurance? - It took about a week from when my medical group said they submitted the paperwork. It took about two months for the medical group to get their act together and get my paperwork together. I being former military, had all my paperwork back to my medical group within a week, ready for them to submit my paperwork. Took them two months for some reason. That was a killer since I was told that they were going to submit my claim the day I handed in all my paperwork. I was pretty bummed out when I called the medical office after a month of not hearing anything, just to find out they had delays in getting tax ID's and the shrink to sign off on their release. But I digress, took a week to hear from insurance.

I hope this info helps at least one person who's trying to find out info on Anthem BCBS.

[Italiangirl86 0]

Hello,

Hearing this is kind of a relief, i am starting my journey.. I go to a consultation and seminar on Tuesday, I hope it goes well i am scared of getting a denial but hearing your story i feel alittle more confident about it. I have Anthem BCBS and full blown PPO and They pay 90% as well. Lets just hope i am as lucky as you and dont need to do a 6 month diet, as i have already been dieting on my own for the past 4 months and havent lost anything. Therefore this is what made me want to get the lap band. I did call my insurance and they said it is a covered benefit but then they said it may or may not require a review...

Good luck to YOU!!!

I've spent the past few months researching and reviewing various forums regarding insurance for the lap-band. The main question I sought to answer was, "Do I need to have the six months supervised diet or whatever". I couldn't find an answer anywhere. What I did find was conflicting, and often ambigious. I even resorted to calling the insurance company to see what they had to say. Nothing. Oh, the insurance company had pleanty to say, but they didn't say anything. No one could find anything stating that I needed the supervised diet prior to authorization. My medical group even called the insurance, and they couldn't get an answer. I requested that when all of my paperwork was ready, that my medical group submit it in any case, and we'll see what would happen.

With the Anthem BCBS, I received a letter in the mail in about a week approving my lapband.

Now, which Anthem BCBS do I have? I don't know. There is nothing on my card stating where they're from, and I work in a different state then where I'm actually insured. I also live in a different state then either of those two, and am having the surgery in another state altogether!

Some questions I couldn't find answers to regarding insurance, and my answers:

Does Anthem BCBS cover lapbands? - Yes. Depends on your coverage as to how much they cover, and also it depends on where you have your lapband, in-network/out etc. I have the full blown PPO and it covers 90%.

Do they require the three/six-month supervised diet? - It was not required for my approval.

How do you find out if you got approved? - I read about people getting approved, but I didn't see how they knew. I received a letter in the mail from my insurance company.

How long does it take to hear from insurance? - It took about a week from when my medical group said they submitted the paperwork. It took about two months for the medical group to get their act together and get my paperwork together. I being former military, had all my paperwork back to my medical group within a week, ready for them to submit my paperwork. Took them two months for some reason. That was a killer since I was told that they were going to submit my claim the day I handed in all my paperwork. I was pretty bummed out when I called the medical office after a month of not hearing anything, just to find out they had delays in getting tax ID's and the shrink to sign off on their release. But I digress, took a week to hear from insurance.

I hope this info helps at least one person who's trying to find out info on Anthem BCBS.

[MissyJake 0]

Wow, Sounds like you have the same Medical and Doctor's office.

Incompetent Boobs.

My insurance BCBS PPO also allowed the full hospital charges. $25,000.

Called and asked them about the negotiated rates with an in network provider. Didn't matter. they allowed the full amount.

Which means I'm on the hook for the 30 % of the left over.

It goes on and on.

I've spent the past few months researching and reviewing various forums regarding insurance for the lap-band. The main question I sought to answer was, "Do I need to have the six months supervised diet or whatever". I couldn't find an answer anywhere. What I did find was conflicting, and often ambigious. I even resorted to calling the insurance company to see what they had to say. Nothing. Oh, the insurance company had pleanty to say, but they didn't say anything. No one could find anything stating that I needed the supervised diet prior to authorization. My medical group even called the insurance, and they couldn't get an answer. I requested that when all of my paperwork was ready, that my medical group submit it in any case, and we'll see what would happen.

With the Anthem BCBS, I received a letter in the mail in about a week approving my lapband.

Now, which Anthem BCBS do I have? I don't know. There is nothing on my card stating where they're from, and I work in a different state then where I'm actually insured. I also live in a different state then either of those two, and am having the surgery in another state altogether!

Some questions I couldn't find answers to regarding insurance, and my answers:

Does Anthem BCBS cover lapbands? - Yes. Depends on your coverage as to how much they cover, and also it depends on where you have your lapband, in-network/out etc. I have the full blown PPO and it covers 90%.

Do they require the three/six-month supervised diet? - It was not required for my approval.

How do you find out if you got approved? - I read about people getting approved, but I didn't see how they knew. I received a letter in the mail from my insurance company.

How long does it take to hear from insurance? - It took about a week from when my medical group said they submitted the paperwork. It took about two months for the medical group to get their act together and get my paperwork together. I being former military, had all my paperwork back to my medical group within a week, ready for them to submit my paperwork. Took them two months for some reason. That was a killer since I was told that they were going to submit my claim the day I handed in all my paperwork. I was pretty bummed out when I called the medical office after a month of not hearing anything, just to find out they had delays in getting tax ID's and the shrink to sign off on their release. But I digress, took a week to hear from insurance.

I hope this info helps at least one person who's trying to find out info on Anthem BCBS.

[thsisme 14]

BCBS: always depends upon the level of contract that your employer has with them as to the amount of coverage. When you call into the customer hotline ask for them to send you a copy of their policy on lapbanc surgery. this policy states what criteria they are looking for. All bariatric cases go through a review process which usually takes approx. a one to two weeks. I made a pest of myself and called enough that they approved my surgery within three days of receipt of the criteria documentation. Everything, was covered with the exception of my share of cost and the cardiologist, assistant surgeon who did not have contracts with BCBS. For those two I paid them and then submitted the totals to BCBS and was reimbursed 60% of what I paid. All in all, I paid under $1,000 for the surgery, hospital stay (1 night), supplies, and surgeon fees.

[finallygettingthere 0]

Wow, Sounds like you have the same Medical and Doctor's office.

Incompetent Boobs.

My insurance BCBS PPO also allowed the full hospital charges. $25,000.

Called and asked them about the negotiated rates with an in network provider. Didn't matter. they allowed the full amount.

Which means I'm on the hook for the 30 % of the left over.

It goes on and on.

Thanks for sharing your story. I thought I was the only one caught in an office where I feel like I'm sitting on the bench, not playing in the game.

I actively have to contact my Dr's office just to get updates, and find out what I am supposed to do next. Granted, they are in a state of change over, but I always thought the customer came first. I always feel like they forget about me, until I either show up at the office, or phone incessantly. I wonder how many other people have had the same issues?

Has yours gotten any better? After you've been approved, how long did you have to wait for them to just give you a surgical date?

Thanks!

[savingface 0]

Hello !!

I have Anthem BCBS and three years ago they would cover WLS..now no. I self-paid. Though the $17,000 was steep, it I had it from life insurance after losing my mom. I think she would approve. Take care and good luck.

[tnt21705 8]

My insurance covered it and I have Anthem BCBS of GA. They approved my case in 2 days. Their requirements were very easy. The dr's office said I have the easiest insurance to deal with.

[Russian_BANDit_inNY 4]

Anthem BCBS of PA here... Live in NJ and doc in NY.

Anthem rep - Anna, who was contacting me every step and was very helpful. Got a phone call from Anna when BCBS did not receive request from doctor's office, then when she did not receive the only form they require in the pile of papers doc office sent, then when she got everything, and back in 30 min with approval.

VS

Surgery coordinator in Doc's office (nothing good to say about her - she made the pre-approval hell for me) told me I will need 6 month pre-opp diet, 5 years medical history in order to be approved - BS

Insurance provided 25 page doc with no mention of 6 month diet or 5 years of med documented 'trying to loos weight' history.

She never returned my phone calls, and took for ever to fax paperwork.

All the frustration with that one person in doc's office definitely worth the way I feel today.

[mrslrjones 0]

It does depend on your employer/insurance agreement. I have Anthem Blue Cross PPO. I just found out that they don't cover weight loss surgeries under my union plan. And believe me, I cried all day and night. My job offers 3 different insurance plans. The one that pays 100% is Pacificare HMO. I am going to switch during open enrollment which is in October. (Ugh!) But I am scared that a HMO won't approve the surgery so easily.

[finallygettingthere 0]

I'm glad some of my information provided some relief to you. Good luck with your journey!

Hello,

Hearing this is kind of a relief, i am starting my journey.. I go to a consultation and seminar on Tuesday, I hope it goes well i am scared of getting a denial but hearing your story i feel alittle more confident about it. I have Anthem BCBS and full blown PPO and They pay 90% as well. Lets just hope i am as lucky as you and dont need to do a 6 month diet, as i have already been dieting on my own for the past 4 months and havent lost anything. Therefore this is what made me want to get the lap band. I did call my insurance and they said it is a covered benefit but then they said it may or may not require a review...

Good luck to YOU!!!

[finallygettingthere 0]

Wow, I wasn't aware of the employer/insurance agreement. I thought it all was the same. That is of course, until I did some research here, but I didn't realize that the employer has to have an agreement. Thanks! I'm sorry you have to wait until October, but good luck with your journey!

It does depend on your employer/insurance agreement. I have Anthem Blue Cross PPO. I just found out that they don't cover weight loss surgeries under my union plan. And believe me, I cried all day and night. My job offers 3 different insurance plans. The one that pays 100% is Pacificare HMO. I am going to switch during open enrollment which is in October. (Ugh!) But I am scared that a HMO won't approve the surgery so easily.

[mrssugar82 0]

I've spent the past few months researching and reviewing various forums regarding insurance for the lap-band. The main question I sought to answer was, "Do I need to have the six months supervised diet or whatever". I couldn't find an answer anywhere. What I did find was conflicting, and often ambigious. I even resorted to calling the insurance company to see what they had to say. Nothing. Oh, the insurance company had pleanty to say, but they didn't say anything. No one could find anything stating that I needed the supervised diet prior to authorization. My medical group even called the insurance, and they couldn't get an answer. I requested that when all of my paperwork was ready, that my medical group submit it in any case, and we'll see what would happen.

With the Anthem BCBS, I received a letter in the mail in about a week approving my lapband.

Now, which Anthem BCBS do I have? I don't know. There is nothing on my card stating where they're from, and I work in a different state then where I'm actually insured. I also live in a different state then either of those two, and am having the surgery in another state altogether!

Some questions I couldn't find answers to regarding insurance, and my answers:

Does Anthem BCBS cover lapbands? - Yes. Depends on your coverage as to how much they cover, and also it depends on where you have your lapband, in-network/out etc. I have the full blown PPO and it covers 90%.

Do they require the three/six-month supervised diet? - It was not required for my approval.

How do you find out if you got approved? - I read about people getting approved, but I didn't see how they knew. I received a letter in the mail from my insurance company.

How long does it take to hear from insurance? - It took about a week from when my medical group said they submitted the paperwork. It took about two months for the medical group to get their act together and get my paperwork together. I being former military, had all my paperwork back to my medical group within a week, ready for them to submit my paperwork. Took them two months for some reason. That was a killer since I was told that they were going to submit my claim the day I handed in all my paperwork. I was pretty bummed out when I called the medical office after a month of not hearing anything, just to find out they had delays in getting tax ID's and the shrink to sign off on their release. But I digress, took a week to hear from insurance.

I hope this info helps at least one person who's trying to find out info on Anthem BCBS.

HI I have one question or u Did Anthem ppo require to go to Center of Excellence? How did u know where to go to get the surgery? I ask because when I went to seminar, and complete all the paper work My Insurance dept saend that The Barix clinic is NOt a center of Excellence... I was bumbed so I told them to send the preauthorzation hopefull they will approve it...

[depressed_bandster 72]

mrslrjones: Please tell me you are not in California...I have Anthem BCBS in CA, I hope it is different and I hope my husband's union plan covers it. I am just starting the process, but SO anxious to get it done!

It does depend on your employer/insurance agreement. I have Anthem Blue Cross PPO. I just found out that they don't cover weight loss surgeries under my union plan. And believe me, I cried all day and night. My job offers 3 different insurance plans. The one that pays 100% is Pacificare ***. I am going to switch during open enrollment which is in October. (Ugh!) But I am scared that a *** won't approve the surgery so easily.