SLEEVE'S APPROVED by ANTHEM of OHIO

[KabinKitty 11]

Just contacted by my surgeon's office this week. They told me Anthem of Ohio contacted them to say they are now covering the Sleeve as a "stand alone" surgery. My information has been resubmitted after Anthem had denied me in August due to the Sleeve being considered experimental/investigational.

I should know within 2 weeks if I am approved and will have surgery in February!!!!

[myrori 55]

Just contacted by my surgeon's office this week. They told me Anthem of Ohio contacted them to say they are now covering the Sleeve as a "stand alone" surgery. My information has been resubmitted after Anthem had denied me in August due to the Sleeve being considered experimental/investigational.

I should know within 2 weeks if I am approved and will have surgery in February!!!!

Best of luck! Keep us posted.

[Was a humpty dumpty 35]

Yay that's great news!

[mp8btpc 33]

Yay Kabin, I remember reading your posts after your initial denial. It is awesome that your insurance has had a change of policy and I am praying you will get your approval. You better run here to post when you get word!

[KabinKitty 11]

Liza,

Are you kidding me? You guys will be second to know, after I tell hubby! I read Anthem's webpage over the weekend and it states that the change was actually in effect since November 18th. It's been a long journey since I first called the surgeon's office in March 2010.

Like alot of people on these boards I have only shared my surgery secret with 2 people (who basically know nothing about the sleeve). I have felt very lonely in this situation, but sharing with all of you has helped tremendously.

I've gone to alot of the surgeon's support meeting and I'm sick of hearing people discussing "the surgery", which is referring to gastric bypass. I always raise my hand and ask a question about the "cadillac surgery", the sleeve. Sometimes I go to people in the room after the meeting to discuss the sleeve with them. None of them had ever even heard of it. I know that's not true as my surgeon discusses all the surgical options at the seminar.

I'm so happy I stuck with my surgery choice and didn't opt out for the band or the bypass. Twice I was asked by my surgeon's office if I would reconsider either of these. I hope this gives someone else the courage to hang in there!!

[KabinKitty 11]

Okay here's the update. I waited till Wed. to do a follow up (the two weeks that my surgeon's ins. gal says it takes to hear back from BC/BS) about if they are approving or denying surgery.

I had to call BC/BS about another situation involving a claim on my hubby. While I had them on the phone and asked them to check the status on my approval for surgery. They told me they haven't recieved any paperwork from my surgeon's office since the initial paperwork back in late July. They had the denial in their records, but that's it!

I called the surgeon's office and talked to the ins gal. She called BC/BS back and refaxed all my paperwork....again. She told me that she got a person's name and that they should have it now. WHEW!

Needless to say I was NOT happy!

More waiting.......................

[KabinKitty 11]

Still no word from BC/BS about my approval/denial. I have the phone number to call the dept. that reviews the paperwork sent in from the surgeon. They decide if you get an approval and I think I will call them to make sure they received the paperwork from the ins. gal.

I had my regular 6 month check up with my pcp on Friday to check my bp and the results of my blood work. I could tell he was SO impressed with everything! My blood pressure was 126/60 (with the help of 3 bp meds), I had lost 11 lbs and my labs were great! He said, "I don't know when I've seen anyone's tryglicerides dropped so much in 4 months time". I have been eating almost no white carbs as I am avoiding almost all wheat gluten and I think that has alot to do with it.

He is very supportive of my having this surgery. It was a great visit!!

[KabinKitty 11]

It seems like I'm using this thread almost like a blog, huh? I hope that's okay.

I called BC/BS again today to see if the paperwork faxed from my surgeon's office ever made it to the "Nurse Reviewer". The nice lady told me it was given to the "Reviewer" last Friday, three days after the surgeon's office faxed it.

She told me my surgery is still under review and that she would suggest I call back the first of next week to find out if it has been approved. I just can't believe how kind and patient these folks at Anthem BC/BS have been with me!

If I don't get approved soon then I won't be scheduled in February. I had my heart set on having surgery during one of the coldest, nastiest times of the year here in Ohio. I would rather be recoperating indoors then, than during the beautiful spring weather!

I will let you all know as soon as I hear something.

[KabinKitty 11]

January 31st I was so discouraged that I emailed my surgeon's nurse and told her I was at my wits end waiting for an answer from Anthem about my approval. I had called Anthem earlier in the week to find out that they contacted the surgeon's office to on Dec 17th for "clinicals" and never heard back from them. When I called the ins gal at my surgeon's office she told me she didn't know of any request for clinicals.

The nurse said she would pull my file and see what she could do. The ins gal called me that same day (Mon. Feb.3rd) and told me she called Anthem again and would continue to do so till she got some answers. The next day (Feb.4th) she called to say that she had been on the phone with them for hours and thought she had made progress. One gal told her I was approved, and then someone else told her that she thought there was an exclusion in my policy!! She told me that she would give them the rest of the week and call back on Monday if she hadn't heard anything.

On Thursday she called to tell me that she got a letter in the mail stating I was approved, so she called to confirm that. When she submitted my paperwork in Dec. she gave them the surgery date of Feb. 2nd, and that still stands. What a long and frustrating journey it's been and I'm glad that part's over!!!

The letter I got states that the surgeon's office had to withdraw the request for inpatient services and then the outpatient ovservation status was approved. It states that if the claim is sbmitted as inpatient, then benefits may not be provided. What a load of mumbo jumbo ins talk! My surgeon has his sleeve patients stay a minimum of two days.

Anyway, it looks like I'm on my way. It really has not sunk in yet, since this last part all happened so quickly!

I am so ready to begin my new life!

[Oopsseedaisy 90]

Boy it has been a ride for you!!! I am so glad it looks like the insurance part is over. Good luck on the upcoming surgery.