Anyone have ANTHEM BC PPO ???

[Magnifi8 0]

...she stated that some insurances require the 6-month diet and weight loss period. Does any with this insurance know if this is a requirement and also for an idea for out of pocket total cost. My insurance will pay for 80% with a lifetime max of $16,000.00 -- any help is greatly appreciated!

[Magnifi8 0]

Forgot to mention that I'm from California.

...she stated that some insurances require the 6-month diet and weight loss period. Does any with this insurance know if this is a requirement and also for an idea for out of pocket total cost. My insurance will pay for 80% with a lifetime max of $16,000.00 -- any help is greatly appreciated!

[kayekaye 2]

Yes I have the same insurance I live in Los Angeles , I really think its up to your surgeon and they submit it to the insurance company . It took only 2 months to get approved without all the red tape . If you live in the area email me and I can get more in detail . I have a friend that have a *** she had lots of risks factors and was in great need for the Lapband , they made her go to class after class before they even consider her for surgery. I had no problem.

[Russian_BANDit_inNY 4]

I have PA A BCBS - no 6 month required for me.

Even thought my doctor's surgery coordinator told me it is - I think they want patience to have 6 months to get more money from the insurance. But I had a nightmare of a surgery coordinator. She might be just one bad apple :-)

I would suggest checking twice with A BCBS. They have 25 page doc ( at least PA A BCBS) and it does not mention any 6 months diet or 5 year weight history ( yes the coordinator insisted to have it as well)

I submitted ONLY what insurance required. Which was a request from my surgeon for approval - 2 page form ( 2 last pages of that 25 page doc the insurance pointed me to)

[thsisme 14]

i have anthem BCBS CA. i called the customer service line and they sent me their policy. no pre-op diet other than the required psych, dietician (they will authorize up to 6 additional classes with the dietician if you need it), seminar, a few others ekg and such. they authorized me in one week.

[1happymama 1]

Hi there,

My blue cross PPO rep told me that they want to see 6 months of continuous weight loss effort within the last 18 months of your doctor submitting the request for approval. Good luck with everything.

[pjsims 1]

I have Anthem also. I live in Alabama. No 6 month diet plan. I called customer service and got all the requirements before I ever went to my surgeon so I knew I had to pay 20%, psych eval once I got all that done I gt approval 6 days later. Good Luck!!

[Magnifi8 0]

Thanks so much for all the info! Trying not to rush things but I've been living with this "issue" for most of my adult life... it's been so long of a journey and I've come to a place where I am now ready to make the "lifestyle commitment".

[portia1972 0]

I am a California with Medicare as primary and Anthem Blue Cross as secondary (and "Tricare brings up the rear.") I had no issues at all with this arrangement. I just provided the insurance information and the staff took care of it all. I have not received statements of what the various insurers paid, and it is 7 weeks later, so I can't be sure there are no leftover co-pays, but no one has mentioned them to me..

[healthychange 1]

I also have Anthem BC/BS. Doc’s office handled all the paperwork for me, and I was approved with no 6 month diet in about 8 days!!! My first doctor visit was June 3 and my surgery is scheduled for July 28.

I suggest you let the doctor do all the contact with the insurance company. I called Anthem several times before finding a doctor and got different answers every time. One time they said I had to do the 6 month diet, another time they said I didn’t. After I was certified, I called Anthem to see if they would cover any travel expenses since my surgeon is out of state, and they actually said the surgery wouldn’t be covered at all! When I explained I had already received pre-certification, the person on the phone said, “Well, I’m looking at your policy and it simply isn’t covered.” She was wrong, but this is why I suggest you let the docs staff, who do this all day every day run the traps for you. I think every employer has a different level of benefits even though it’s all Anthem, so you really won’t know for sure until the doctor requests precertification.

Good luck!

[jojo323 1]

Hello ,

I have BC/BS ppo they never told me to loss any weight . It just tuck a about 8 months for them to approve me. Once i got approve I got the lapband. Till today I pay out of my pocket about $775.00

[jade0224 1]

Hello ,

I have BC/BS ppo they never told me to loss any weight . It just tuck a about 8 months for them to approve me. Once i got approve I got the lapband. Till today I pay out of my pocket about $775.00

i also have CA anthem bcbs. i just had my first consultation yeterday. there was no required pre-diet however before they would submit pa request. i have to see the psych - nutritionist-gi xray-sleep study. this facility requires that i do a pre class at $400 and $800 post-op. its about 1450 in out of pocket fees. i dont really know if the additional cost only apply to this facility because its my first consult but my i know my insurance covers 100% of the procedure.