ANTHEM BCBS OF OHIO

[GrownWoman84 3]

Does anyone have Anthem BCBS of Ohio? I have this insurance and I've heard conflicting answers on whether or not they require 6 months of medically supervised weight loss. I have called my insurance company 4 times and gotten different answers. The first time I was told there was no such requirement, that everything was done "on the honor system" (doubtful) and then the second time I was told there was a 6 month requirement. The 3rd call the representative didn't know and the fourth time I got an answer similar to the first time I called. I'm inclined to think that I don't have the 6 month requirement. However, I talked to a nurse at the weight loss center I'm going through and she said that Anthem BCBS is one of the trickier insurance companies and she's some people get denied (and then have to appeal) due to not having the 6 months of documentation, even though the insurance company didn't list this requirement in the benefit. Any input would be very much appreciated. I'm too frustrated to be at the very beginning of this process. Thanks!

[Roo101769 742]

I have Anthem BCBS of Ohio and I went through the same runaround concerning medically supervised diets. When I first called to ask about coverage ( this past summer) I was told we did have coverage. I asked about the diet because my old insurance required 12 consecutive months!!! I was told there was no medically supervised diet restriction. So I proceeded on. Before I went to my first consultation with the surgeon his office called and told me I wasn't even covered per what insurance told them! It was a matter of my company had bought into a standard plan, but had chosen to INCLUDE WLS as a covered item. Sort of an a la carte item. Anyway, as I began jumping through the prerequisite hoops the surgeon's office said they were told by my insurance I had a 6 month diet requirement, not the information I was told. I had to go back and forth between insurance and the surgeon to get it squared away. After several phone calls it was FINALLY determined ( after getting a manager involved at BCBS) that the plan states I had to follow any medically supervised diet restrictions set forth by my surgeon or nutritionist. Well that is an entirely different thing than it being an insurance requirement!! So after some trial and error I got through it all and was sleeved 10/21. On the plus side..My approval took less than 24hrs to receive so kudos to Anthem for that!!! Good luck!

[GrownWoman84 3]

So if you don't mind me asking...did your surgeon or nutritionist put you on a diet and if so for how long? I don't mind waiting but if I don't have to I don't see the point of wasting the time or the money on copays for unnecessary office visits. Thanks again!

[Roo101769 742]

Nothing out of the ordinary. My surgeon's office does a mandatory 10 day pre op liquid diet to shrink the liver, but that was all. In fact I saw the nutritionist once and she said I knew what I was doing! Of course back in August I decided to start eating high Protein, low fat/ low carb/ low calorie on my own. I wanted to get used to that type of diet before the surgery. But I had nothing additional put on me by the NUT or my surgeon.

[Roo101769 742]

For the record I went to my first WLS seminar end of July. My first surgical consult was 8/6. Everything else was done and paperwork submitted by first of October and I was sleeved 10/21.

[GrownWoman84 3]

Thank you so much! I hope my journey ends smoothly as well. I hope everything is going well for you in your new life! :-)