Just starting, Insurance question Anthem BC/BS Ohio

[Bobby46 327]

Hello. I have been looking into sleeve surgery for a long while now. Finally submitted my forms to OSU Medical Center in Columbus OH. My Insurance said they don't have requirements, just whatever OSU deems necessary. Does that sound right for anyone else with this insurance? I have read a couple posts where the Dr submitted everything to BC/BS in other states and it came back requiring proof of failed dieting with PCP. I have had the psych evaluation, medical and nutritional consults. Next week I start a 4 week pre/post nutritional class 1x a week. After that they will schedule a meeting with the surgeon. Does this sound about normal? I don't want any surprises later. Thanks!

[shawna978 3]

I have anthem BCBS as well. The nutritional classes qualified as my medically supervised "failed" diet

[Teachamy 1,042]

There were no requirements for me either. (Just that I met the criteria for surgery--35 BMI with co-morbidities) I had paid my $700 out of pocket, so my surgery was covered 100%. I have Anthem BC/BS of Maine.

[michelle_e2006 33]

I have Anthem BC/BS and they too didn't have any requirements or waiting period. However, when my surgeon submitted all of the info to the insurance company for approval, the fact that I had a history of "failed" diets like Jenny Craig, Weight Watchers, etc helped with the approval. Good Luck!

[Its about me 1]

I have bcbs originally told in Nov nothing was required preop but in Dec I was informed I had to do a 3month diet (new requirement).

I also had to provide documentation of previous diet attempts,exercise programs, primary doctor recommendation letter and a statement that you have not smoked for 6mos or substance abuse for 1year. Unfortunately, I saw primary timely mid March but at time of my consultation the documentation had yet to arrive. Slight set back but I just plan to continue calling until it is submitted to avoid further delay in the insurance review process. My goal is to have surgery late May.

[Bobby46 327]

Good morning all! I think I will call my insco again on Monday and push for requirement information. I have talked to a couple reps when I first started looking into surgery and they were not very helpful....I felt like they really didn't know how to answer my questions. The insurance documents are so misleading. They make it sound like the surgeon's approval is all I need then it has a clause saying there are more details that must be read elsewhere in the documents.....which I couldn't find for the life of me! I have a list as long as my arm of all the diets I tried and failed and a couple that worked really well but I gained the weight back afterwards.....Weight Watchers, Jenny Craig, Adapex diet pills with my doctor. I have nothing documented by a doctor other than the Adapex pills. Cross your fingers for me. I will let you know what they say on Monday.

[hannysgrammy 42]

Hello. I have been looking into sleeve surgery for a long while now. Finally submitted my forms to OSU Medical Center in Columbus OH. My Insurance said they don't have requirements, just whatever OSU deems necessary. Does that sound right for anyone else with this insurance? I have read a couple posts where the Dr submitted everything to BC/BS in other states and it came back requiring proof of failed dieting with PCP. I have had the psych evaluation, medical and nutritional consults. Next week I start a 4 week pre/post nutritional class 1x a week. After that they will schedule a meeting with the surgeon. Does this sound about normal? I don't want any surprises later. Thanks!

Bobby. I too am going to OSU. I will going having RNY on May 19. With Dr. Needleman. I had to have a throat scope . nutionest class with I had mine in Marion. 1 day a week for 2 weeks. I got blood work done EKG. Then came the physo. Appt. Then the sleep study. With then I was placed on cpap. I have to be compliant for 30 days cause they found I have sleep apnea. Well only 12 days left on it. Then lincare will download it to him. I have A them Bcbs as my insurance took them 1 day to approve. Waiting for my preop appt. However I won't get that till cpap done. Hang in there

[Justicenga 31]

I have Anthem too. I had no requirements. My first appointment was in January and I was sleeved march 31. Probably would have been sooner but the weather caused some appointments to be rescheduled.

[Bobby46 327]

Thank you! I hope all goes well for you. Please let me know how everything works out for you. I'm excited and nervous. I have my endoscopy on the 25th with Dr. Makami. Not looking forward to that! Pretty sure its no fun.

Hello. I have been looking into sleeve surgery for a long while now. Finally submitted my forms to OSU Medical Center in Columbus OH. My Insurance said they don't have requirements, just whatever OSU deems necessary. Does that sound right for anyone else with this insurance? I have read a couple posts where the Dr submitted everything to BC/BS in other states and it came back requiring proof of failed dieting with PCP. I have had the psych evaluation, medical and nutritional consults. Next week I start a 4 week pre/post nutritional class 1x a week. After that they will schedule a meeting with the surgeon. Does this sound about normal? I don't want any surprises later. Thanks!

Bobby. I too am going to OSU. I will going having RNY on May 19. With Dr. Needleman. I had to have a throat scope . nutionest class with I had mine in Marion. 1 day a week for 2 weeks. I got blood work done EKG. Then came the physo. Appt. Then the sleep study. With then I was placed on cpap. I have to be compliant for 30 days cause they found I have sleep apnea. Well only 12 days left on it. Then lincare will download it to him. I have A them Bcbs as my insurance took them 1 day to approve. Waiting for my preop appt. However I won't get that till cpap done. Hang in there

[hannysgrammy 42]

Thank you! I hope all goes well for you. Please let me know how everything works out for you. I'm excited and nervous. I have my endoscopy on the 25th with Dr. Makami. Not looking forward to that! Pretty sure its no fun.

Our insurance acted fast. I will keep u posted and u do the same

[bbwcraftycrafter 0]

I am to going to osu to get all done I just got all paper work filled out and ready to fax to them I am nervous how are you doing Bobby?

[Bobby46 327]

Hello bbwcraftycrafter! I am going thru my pre/post op nutrition classes. I have my 2nd one tomorrow. I have loved the whole OSU experience. Very impressed that they just call periodically to see how I'm doing and to see if I have any questions. What doctor/nurse does that anymore!? I submitted my paperwork in late Feb and very quickly had my psych eval with Dr. Kramer. It took a chunk out of my day but it was all good. Then I had appts with nutritionist (questions about eating habits, if you drink pop, what you hope to accomplish weight loss wise) and medical (weigh in, a million questions, blood work and EKG). Very shortly after that I got a call to schedule the nutrition classes and the endoscopy. I am crossing my fingers that bs/bc will not require anything additional....but I wont hold my breath! lol When they called to schedule the nutrition classes the lady said that June should be possible for surgery depending on insurance approval. I hope everything goes as smoothly for you as it is for me!

[bbwcraftycrafter 0]

I have been asked by every one of my Pcp to do surgery but I was scared. I have embraced this is what I have to have done I am looking forward to getting this all done my insurance already said they do approvals only thing I think might stop anything is 9 months of supervised dieting, exercise, I have kept a journal of what I ate since January of this year and weighed in every month to every other month with my doctor. Where are you from? I'm 36 from mansfield ohio it is nice to meet some one from Ohio.

[Bobby46 327]

Hello. I'm 46, from Springfield. Kind of a drive/pain to do this at OSU but it will all pay off. Have you been to any of the nutrition classes yet? There are about 20 or so people in them. Everyone seems to be very friendly. Its such a personal experience it takes a while for people to open up. I'm still feeling the waters. I haven't been keeping food journals yet but I think I might just start. I did Weight Watchers about 15 yrs ago and lost a lot of weight. They encourage journaling and it really helps. I kept it off for about 8 yrs before I started back with bad habits again. I'm hoping the surgery will help me keep the weight in control. I've done medifast and other diets....they all work, honestly, but its just impossible to keep it off. I really hope this works. I'm excited and scared to death. I have a 12 yr old son that is worried about me. I told him so I wouldn't scare him. Its good to talk openly with him about it. ......Also, did you know there is a forum for Ohio people too? When you open Bariatric Pal you can scroll down and there is a forum for several states. I think I've seen someone there from Mansfield. It might have been you, lol! Anyway, I will pop in here every now and again. Feel free to look me up!

[hannysgrammy 42]

I have been asked by every one of my Pcp to do surgery but I was scared. I have embraced this is what I have to have done I am looking forward to getting this all done my insurance already said they do approvals only thing I think might stop anything is 9 months of supervised dieting, exercise, I have kept a journal of what I ate since January of this year and weighed in every month to every other month with my doctor. Where are you from? I'm 36 from mansfield ohio it is nice to meet some one from Ohio.

Wow bobby I am from Marion Ohio. I to am going to OSU. Preop is may 13. I also have Bcbs