Getting A Bad Feeling About Approval

[audreycat123 59]

My surgery scheduler has told me on two separate occasions that lap band is covered on my policy, once before my initial consult and then when we scheduled all the classes and psych and diet eval. However, today I got the eob back from the insurance concerning the first class I attended six weeks ago. Payment was denied. When I called anthem they said that nutrition classes for the treatment of obesity were not covered. It's through my husbands insurance at rolls Royce.

How the heck are they going to pay for a 15 thousand dollar surgery if they won't pay for a 75 dollar nutrition class. I haven't called the doctors office because I do not want to draw attention to myself or convince them they are wrong. But what do you guys think?

[newme37 16]

It is very common for any type of weight related visit to NOT be covered, yet the band it's self to qualify. I've been a claims rep for various companies for years and nutritional counseling is most often not covered as any type of diet doctor, diet pills or other plan would also not be.

I would call myself and ask if weight loss surgery is covered and I don't think you should be discouraged by the denial . Once surgery is approved the nutritional claim will be reconsidered as part of the lap band approval.

Keep your head up and good luck !

[audreycat123 59]

Thank you I feel better already. I am driving myself nuts waiting to get started with my new life plan! I should have less than a month or so to go. Somehow the closer I get the further away it seems. if this all ends with a denial I think I will pass out till next year from mental anguish!

Thanks again.

[newme37 16]

You are welcome ! I can guarantee you that the Dr has called to verify coverage before moving forward with your process. The way insurance companies are set up, many claims are examined by a computer and not an actual person as there are never enough actual people to "touch" every claim. If it is a straight forward office visit or a simple type of claim or a non covered service, the computer is set to adjust it and no one ever sees it. Once you receive approval, there is an exception made and noted under your policy # all visits regarding your surgery after that point will be kicked back to an actual person to review. Rest assured there is no one sitting behind a desk deciding whether or not your surgery related visits are covered at this point

[newme37 16]

Here ya go !

http://www.obesitycoverage.com/insurance-and-costs/am-i-covered/check-my-insurance/item/anthem-bcbs-requirements-for-weight-loss-surgery

[ElleG 394]

I had my surgery approved and paid $65 to see a nutritionist. The insurance would not cover it. My surgery was $40k I had a heart issue after and had to stay a extra day in the hospital. I figure I could cover the $65 since they paid that. Don't be discouraged. Good luck to you!

[audreycat123 59]

Thanks guys! I feel so much better. Newme37 you are so right, the place I am going to does so very many lap bands I am sure that they know how to check my insurance before my initial consult (which has already been paid for by anthem) it also looks like from your link that anthem is not the one requiring a three month program, it must be the practice that requires it. Everything you say makes sense and makes me feel better. Thank you.

[hippychick74 22]

My surgery scheduler has told me on two separate occasions that lap band is covered on my policy, once before my initial consult and then when we scheduled all the classes and psych and diet eval. However, today I got the eob back from the insurance concerning the first class I attended six weeks ago. Payment was denied. When I called anthem they said that nutrition classes for the treatment of obesity were not covered. It's through my husbands insurance at rolls Royce.

How the heck are they going to pay for a 15 thousand dollar surgery if they won't pay for a 75 dollar nutrition class. I haven't called the doctors office because I do not want to draw attention to myself or convince them they are wrong. But what do you guys think?

Don't start worrying I think you will be OK. I have Anthem and knew upfront that I would have to pay for the nutrition class. I was approved and banded on 7/20/12.