Anthem Blue Cross Requiring 3 Months of Nutritionist's Evaluation

[st2011 29]

There is another thread here about blue cross that a woman just posted and it makes sense that they give different contracts with different employers.. My husband works for California emergency physician. C.E.P . And works in the ER at El Camino hospital. So I think it might have been easier covered by our plan

Ok I guess I need to call them Monday and find out what's up for 2013.

[Kennedy310 33]

There is another thread here about blue cross that a woman just posted and it makes sense that they give different contracts with different employers.. My husband works for California emergency physician. C.E.P . And works in the ER at El Camino hospital. So I think it might have been easier covered by our plan

Yes, there probably are some nuances amongst plans. My plan is a personal PPO with Anthem. I pay for the entire thing since I am a freelancer. And I have a crazy high deductible... $4100. The requirement of the 3 month nutritional evaluation may be unique to my sitaution.

[NDN_RN 527]

Feeling pretty bummed this morning. My doctor's office informed me that Anthem Blue Cross will not make their decision on my surgery until I have 3 complete months of evaluations from a nutritionist. I know it's only a setback and it definitely could be worse but I'm still very annoyed since I had to wait till less than a week before the planned surgery to find it out.

Has anyone had a similar experience? Is it worth calling the insurance company to see if they will waive this requirement?

I had my surgery on Oct 3. I have Fed BCBS and i had to self pay for 3 nut visits. They submitted after the 3rd visit. After a slight glitch with one nurse trying to deny the surgery, due to low BMI (but had a comorbidity) it was approved a week later by another nurse. They wont wave it.

Done Did It!

[Kennedy310 33]

I had my surgery on Oct 3. I have Fed BCBS and i had to self pay for 3 nut visits. They submitted after the 3rd visit. After a slight glitch with one nurse trying to deny the surgery, due to low BMI (but had a comorbidity) it was approved a week later by another nurse. They wont wave it.

Done Did It!

Thanks! This does indeed sound like the same requirement I have. I spoke to my nutritionist & since I met with her a month ago, my next meeting with her serve as my first month's evaluation. So, that is at least a silver lining in this setback.

[Kennedy310 33]

Happy to report that I was finally approved for gastric sleeve surgery!

It was quite a frustrating journey. They initially denied it because I'm having surgery out of my home state. Then, approved it incorrectly as an outpatient procedure but denied the hospital (which I had confirmed was in network months ago). They eventually got it all correct after a few tries.

It's a relief to finally have everything approved and in place.

[navyma 68]

Thanks. I probably wouldn't be as disappointed as I am if I had known sooner. But with less than a week to go before the planned surgery' date=' I was in the headspace of being ready to do it.

But you're absolutely right... it could be worse & there is a benefit to working with the nutritionist. My trip to the gym this morning was not in vain. Thanks for the support! I appreciate it.[/quote']

I have them also & I was told its a 6 month wait. So I feel your pain. And... Since my drs are all in the hospital it gets billed as an "outpatient hospital visit" and I get charged an extra $130 per visit per dr. They won't bill it any other way. And BC won't pay. I just know it's going to be all worth it in it end. I'm waiting for ins approval right now. If they don't approve me for some reason I'm gonna LOSE IT on BCBS!! . Your 3 months will fly by!

[taylokat 180]

Happy to report that I was finally approved for gastric sleeve surgery!

It was quite a frustrating journey. They initially denied it because I'm having surgery out of my home state. Then' date=' approved it incorrectly as an outpatient procedure but denied the hospital (which I had confirmed was in network months ago). They eventually got it all correct after a few tries.

It's a relief to finally have everything approved and in place.[/quote']

Congratulations! Do you have a date yet???

[Kennedy310 33]

Congratulations! Do you have a date yet???

Thank you! Yes, I'm scheduled for March 29th. I'm looking forward to the next step in the journey.