*** Insurance Anthem Blue Cross Question?

[Megbd 3]

I've called my insurance regarding having the lap band surgery and what my coverage was and they told me I have no coverage for bariatric surgery unless they got a letter from the dr saying that it was medically necessary. I have yet to see a bariatric dr(I'm going to a seminar on Tuesday) yet and I'm a little scared/nervous that he won't see it medically necessary for me. I've been 100+ over for about 6 years now, my BMI is 45 but I have no diabetes, high blood pressure or sleep apnea or anything like that. (i would like to prevent that). I've tried dieting on my own and have been unsuccessful. Has anyone had any experience with having there Dr write up a letter? And what we're some of the things that he used to persuade the insurance to get the surgery if you didn't have any comorbidity?

**sorry so long**

[Megbd 3]

Oh I forgot to add I have a *** and I have already received an approved referral to have a consultation with a bariatric surgeon

[stept04 465]

I believe if your BMI is over 40 you don't need to have any health conditions related to your weight, if your BMI is 30 or over you have to have some health conditions related to your weight. That was how it was for my Dr. and insurance. It could be different with different insurances. Now if you pay out of pocket I guess it would just be up to the Dr. , and I think it is a BMI of 30. Like I said that was in my case. There are some well informed people on this site that I'm sure can give you more detailed information, I'm sure they will answer this post. I would have thought your insurance would have given you all the details, if not the seminar should be informative about how insurances work, they may even be familiar with yours personally if they have already worked with it. Good luck

[Megbd 3]

My insurance also told me that any pre surgery requirements like a 3-6 month monitored diet is up to my medical group and doctor to decide. I thought it was up to your insurance for things like that?

[kng39212 33]

I have BcBS anthem and all you will need is that letter if medical necessity and psych veal and mines was approved in Monday of this week. Your BMI is enough were you prob want need any other co morbs

[stept04 465]

Yea, I thought so too. But it seems that the insurance has certain criteria and then the Dr.'s have their criteria. I'm sure it will all work out for you. Mine surprisingly went pretty smooth considering the insurance I have which is is ChampVA it's a government type of insurance my husband is disabled from the Marine Corps he got it through the VA. So, if I got approved and did not have to jump through to many hoops, you know how the government is. I think you will be alright.