Anthem Blue Cross CA ..PPO

[sarahzamudio1091 185]

Hi my fellow sleevers ! My sister wants to know how to go about the first process with this type of insurance. I was sleeved on jan 5 th. just wanted to know if its pretty much get the referral from your doc. He sends it to the insurance Than go from there ? And how much is the co pay for PPO

[iegal 460]

I had BC/BS Anthem PPO 2010. Wish I could give you advice but BCBS didn't approve SLEEVE surgery until Oct 2010. When did I get sleeved? 9/17/10 Yeah, I self paid since BCBS refused to pay less than two weeks before offically approved. If I knew BCBS would start approving two weeks later, I would have waited. Argh. Thanks for letting me vent.

Good luck to your sister!

PS- I think BCBS has a 6 month supervised diet involved before surgery is approved. Do a search of this topic in top right corner selecting forums. Enter in BCBS Anthem or BC/BS Anthem or similar

[No game 14,437]

[edit]

Like what she said down there !!

Some days I can't talk or write...

[my3kids4life 22]

I have Anthem BCBS PPO, which doesn't require a referral. However your sister should first check her company's WLS requirements if she meets them she can schedule her on appt. with a suregon.

PS - My company didn't require the six month supervised diet which is why she wants to reach out BCBS and inquire if her company cover WLS if so what are the guidelines does she have to meet. Good luck to you sister

[SuperblyInsane 15]

I had this insurance last year and wished I had taken advantage of it when I had the chance! I have 3 friends who had surgery, one paid a total of $500 and the other 2 paid nothing at all. I'm not sure what the difference was in their policies though. I do know they had to do 6 months of physician supervised weight loss and meet specific BMIs (40 without co-morbidities I believe)

[shayv123 96]

I had this exact insurance. NO supervised diet, NO out of pocket cost, just the normal blood test, phycisian clearance, sleep study, psych clearance, ekg and off to surgery i went......

[sarahzamudio1091 185]

Thanks guys much appreciated

[shayv123 96]

I will also add that I had one surgeon office try to force me to do the 3 mths because she didnt want to hold the line and get the specifics of my policy. I call UM Dept myself and the told how to print out exactly what was required so I would have a copy.

[cresh78 25]

I have Anthem Blue Cross CA PPO. I had to get a referral from my PCP then I went to the bariatric surgeon. He then referred me to the psych and nutritionist contracted with him and my insurance. They submitted my paperwork and I was approved in 3 days. U only need the psych and nutrition appointments prior to having the paperwork submitted. I have my surgery on March 7. I'm not sure what the out of pocket will be. I was told I just had to meet my deductible.

[sarahzamudio1091 185]

That's weird I wonder why some need a referral and some don't ? I thought if u have PPO u wouldn't need one. Only for Hmos

[shayv123 96]

Every policy is written differently

[cresh78 25]

It wasn't technically a referral. My PCP just gave me the names of the in network bariatric surgeons.

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[sarahzamudio1091 185]

It wasn't technically a referral. My PCP just gave me the names of the in network bariatric surgeons.

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And then u just make an appt to see them ?

[cresh78 25]

And then u just make an appt to see them ?

Yes.

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[lessofmeismore 1,405]

I have BCBS and they do not cover WLS on my policy coverage.

Every company's co pays and coverage is different.

She will need to get her medical coverage benefits book from her company.

Hope she finds out good news!!

I went self pay