Anthem Blue Cross Employers Funded Insurance

[lolamadora 0]

I am new at all this and recently found out that although my insurance is with anthem blue cross of califrnia PPO that blue cross bears no liability in that they simply administer the plan. My insurance is self funded by my husbands larger employer who at the beginningof march 1, 2012 was still working out the specifics of the SPD and thus could not provide me the detailed description of what specifically they covered in regards to bariatric surgeries...it just says that bariatric services are not covered if it is not medically necessary. I called 1800 thin here in California. I have been seen at Dr Johnson's office where I have had a sleep study done, upper GI, ultra sound of my abdomen, and bp taken,weight,labs. The office is clearly efficient and told me I meet the core mobilities being that I have high blood pressure, sleep apnea, and a BMI of 38.5%. Has anyone delt with insurance that is self funded by an employer? Seems wrong that my insurance began jan 1, 012 yet they are still.having a team of lawyers Iron out the details of the SPD. I also found out that the governing agency over these types of plans is a Federal agency which name escapes me and I was told that basically they could get away with never showing me the SPD....I work in the medical profession and I feel blind sighted by all of this. I am just wondering if any of you have ever dealtwith this..Thanks in advance;-)

[NWgirl 574]

I do not live in California, but have heard others say to be wary of 1800-thin due to some serious lapses in patient care reported. Good luck and hopefully your insurance is figured out soon!

[jayeedee 7]

Yes, avoid 1800Get Thin. There are a ton of lawsuits against them happening right now, and band providers have ended their relationships with them in the past month. Generally medically necessary means a BMI of over 40 or a BMI of over 35 with two co-mobidities (blood pressure, high cholesterol, sleep apnea etc.). I went through anthem and those were my requirements, but I would call and speak to someone and double check, and go through a doctor that is associated with a center of excellence. Anthem likes those.

Good luck!

[mandagay 93]

I had my surgery done in tarzana. They staff is amazing and most of the nurses are banded themselves! They took care of everything for me and come down to Santa Ana (I'm in irvine) for my aftercare. The doctors have me their personal cells and always answer my texts. I'd be happy to get u their info if u need it

[lolamadora 0]

Thank you for your information Aspiring avangelist I did not know this and that makes me concerned. I did look up the doctor in the California Boards also found him licensed in two other states he has been doing laproscopic procedures for what appears to be some time. I found it interesting that they are a one stop shop everything is done in house...the sleep study, endoscopy, ultra sound. I have yet to be billed they just keep telling that my copay is 1,000 from start to finish. I did have a chance to see the surgery center which is a 1 block distance from the hospital. That being said I have spent two weeks trying to get my sleep study results. I have yet to get any information only that they received prior approval before I had these various procedures by the insurance company. I went to see my primary doctor today and he was a little concerned that they were not offering the results. I don't know what to think. My point of contact for the office she is very slow at responding to emails and I am starting to get some red flags. LBT addict, wow! did not know they were having law suits and such. When you say band providers are ending their relationship with them what does that mean? Does that mean the doctors that are with 1800 thin are leaving the group? Junior Guru is the practice you go to part of the 1800 thin group and thats amazing the doctors answer texts? That would be a 6 hrs drive though to get to Santa Ana but it would be nice to have a doctor recommendation for the Bay Area for the fills. My doctor also recommend the sleeve but I would much rather have the band and still want to proceed. I don't mind taking the time to research all this out I have been overweight for a long time what is a few more months! LOL! ...

[jayeedee 7]

I mean allergan said they are no longer supplying doctors associated with 1800lapband with bands:

http://articles.latimes.com/2012/feb/02/business/la-fi-lap-band-20120203

They do not want them to be associated with their brand, because of all the problems, and proportionally high incidents of complications and death their clinics were/are having.

Also, I would highly suggest that, if it is at all possible, to have the operation in a hospital, because we never know how we might react to general anesthesia and it is just safer to have that done in a fully equipped hospital when we have the means to do so.

The centers of excellence are selected by BCBS, and that is where you will get the best coverage. If you log on to the anthem site, you can look up the procedure and the cost by location to choose the most affordable center of excellence.

[KimberlyB 0]

I don't know about Anthem Blue Cross but my husband works for Union Pacific RR and has United Health Care. I was told that I WAS preapproved for everything and had my surgery in January of 2011. Since then I have had all my follow up fills untill today! Today I went into the Apple Valley office and found out that my insurance company has NEVER made a single payment! Not on my surgery, the pre tests nor the follow up fills! I have spent hours on the phone with my insurance company and with 1-800-get thin over the last year and still have not been able to get my surgery paid. The insurance co tells me that the billing office hasn't sent me all of the required paperwork, tests ect... and the billing office keeps telling me they have. I had to sign papers for 1800 get thin to take my insurance to court about 6 months ago. Today I needed a fill and couldn't get it. Somehow my port has moved and the plat side that the needle goes in couldn't be found by the Dr. that was there today. I couldn't have aflourescopy to find it and to check on the position of my band because of the none payments by my insurance. I am now in the middle of a war between the two and I can not get the care I need! GREAT! I don't know what I am going to do.