Anthem

[heatwhip 166]

Anyone have BCBS Anthem and get denied? I have almost 38 BMI, severe obstructive sleep apnea, high cholesterol (on meds), very high triglycerides, thyroid issues and fatty liver. My doc thinks I wi be good and so do I but I have read so many horror stories.

[Sadtosaygoodbye 256]

I have Anthem Insurance and they are pretty straight forward with their requirements. As long as you follow these guidelines as well if any, that your employer has in place you should be good to go. A bit of information I can give you is that, Anthem processes their bariactric cases by having the insurance coordinators call to establish a case first. They are then given a case number, once the Nurse is ready to review the case they call the office and have them fax your file. This is where the errors are usually made, it can and will hold up your case.

I am speaking from experience myself and a bunch of other people who had surgeries in March experienced. The coordinators will blame it on Anthem, but it's just not the case. Speak to your coordinator prior to him/her submitting your claim to avoid this issue. Once they have submitted your claim call Anthem for your case number. You should ask for the medical management department, not the regular claims information number because they cant see the case from their system. Anthem usually has a pretty quick turn around thankfully. I wish you much luck on this wild and crazy ride.

[uccmart 23]

Anthem is very specific on what qualifies for the procedure. If the provider did not fully document all your co-morbiditiesm and 6 months of wieght checks, then they will deny. The doc's office just needs to get all the ducks in a row and if you truly meet the requirements, they will approve it.

[uccmart 23]

I have Anthem Blue Cross of CA. My docs office called on Tuesday and said they have everything they need to submit to insurance. I am super nervous. My BMI is fourty-something and have co-morbidities. I can't wait. I am so excited to finally do it.