Anthem Blue Cross PPO through employer

[zabby 18]

I know this may have been asked and answered but I haven't seen it, So here we go, in the policy it states:The individual must have actively participated in non-surgical methods of weight reduction; these efforts must be fully appraised by the physician requesting authorization for surgery. What does appraised by the physician mean? Just that he knows of your attempts or does it have to be documented?

​I go for my first visit with a surgeon next week and I just want to get as much info together to expedite the process.

Thank you for your help

Medical Policy.doc

[Georgia Pritchett 53]

Same wording as mine (CalPers PersChoice administrated by Anthem Blue Cross). My primary wrote a letter about what I had done, I wrote a short (2 page) history of my dieting with approximate weights, dates, and diets, and gave those to the surgeon who talked to me about it. Not sure what he sent but I didn't have to do any more diets (they don't require it) and was approved the first go round (and sleeved last week!)

[Peekboo 472]

I have anthem as well and my surgery office gave a form with weight loss methods listed and I just put the dates and how much I lost and if and how much I gained back.

[zabby 18]

OK thank you that makes me feel so much better!

[Alfie 58]

I just got off the phone with my insurance Anthem BC BS through my employer Verizon. The guy they transfered me to was a doll. a nurse. He said that since he is now familiar with me he took my case. I haven't even gone to my first appointment yet but I go to the consult on October 1st. I will be a band to sleeve revision.

This is what he told me and asked me to write it down that this is what they'll need.

1) dr should highlight mechanical problems. he said that sometimes they don't do it right.

2) should state height and weight beginning before banding and current weight.

3) psychological exam

4) registered dietician evaluation

5) medical clearance

he also said that if the doctor asks if they need a medically supervised diet for 6 mos etc that the answer is NO

Lastly, I asked him about all those other tests people talk about like sleep test, venus doppler etc and he said they don't need that but the doctor may.

Hope that helps.

Alfie

[fitdrea30 41]

Alfie my husband works for Verizon and so we have same insurance company. How long should the medical supervised visits supposed to be? My bariatric clinic tells me 6 months.

[Alfie 58]

Alfie my husband works for Verizon and so we have same insurance company. How long should the medical supervised visits supposed to be? My bariatric clinic tells me 6 months.

Hi there Drea. The nurse that I spoke to said they do not require a medically supervised diet of any kind. But he had all my particulars so maybe he said that for me since I already have the lapband. You should call there; they are very nice and do try to answer all of your questions. If you call though, ask for a nurse to answer your questions. I hope that helps. Alfie

[fitdrea30 41]

Thanks I will as many changes with insurance companies have taken place lately. When I called back in June it was 6 months and maybe it's because you already are banded.

[angierue 214]

I work for Verizon as well and have Anthem. I was feeling pretty good until my patient advocate emailed me saying the insurance company wanted examples of doctor supervised weight loss attempts within the last three years. Thankfully, I went to a doctor two years ago and was put on phentermine so there's a record of that. Hopefully that is all they need.

My clinic requires a sleep test, which I'm having 10/2 and that I lose 10% of my initial weight before they'll schedule. I'm shooting for 11/4 and need to be at the goal weight by 10/15 (my next appt). I've got 20.7lbs to go!

If I don't get everything completed by then, I'll have to wait until January (I'm an assistant manager in a retail store and can't be out during the holidays).

Good luck to y'all!

[Alfie 58]

Thanks I will as many changes with insurance companies have taken place lately. When I called back in June it was 6 months and maybe it's because you already are banded.

I think you're right. I just reread what they will need from me and one of the things is michanical failure etc witht the band so I guess it is because I was banded and already went throught the 6 month thing when I got the band albeit I had Aetna at the time.

[Alfie 58]

I work for Verizon as well and have Anthem. I was feeling pretty good until my patient advocate emailed me saying the insurance company wanted examples of doctor supervised weight loss attempts within the last three years. Thankfully, I went to a doctor two years ago and was put on phentermine so there's a record of that. Hopefully that is all they need.

My clinic requires a sleep test, which I'm having 10/2 and that I lose 10% of my initial weight before they'll schedule. I'm shooting for 11/4 and need to be at the goal weight by 10/15 (my next appt). I've got 20.7lbs to go!

If I don't get everything completed by then, I'll have to wait until January (I'm an assistant manager in a retail store and can't be out during the holidays).

Good luck to y'all!

All the best to you. You can do it on the liquid diet. I was able to lose 10% of my weight within a short period with the liquid diet (I think it was about 5 or 6 weeks).

[Peekboo 472]

I have BC/BS Federal and add to list all the diet attempts that I had tried in the past basically the year I tried them the date I tried them how much weight I lost and then how much if any I regained. My surgeon had a form that has different types of weight loss places that you may have gone Yee. Weight Watchers, Atkins, the different places that you buy the meals and lose weight like Jenny Craig Nutrisystem. I think I had to list at least three or four but that's all they required from me it didn't have to be listed in my medical record thru my PCM I just had to be a tent that I said I try to do. I would call your insurance company and get verification on exactly what they need that would be the best thing good luck with that. I am using voice to text on this message so if there are any errors forgive me.

[justdream 15]

It means documented by PCP, I have BCBS NC Medicare Blue, I had to do 4months documented I have done all tests ,EKG, EGD, blood , Nut, physc everything but one last visit to PCP on Nov 6, I have been told that with type two diabetes , high blood pressure and sister and dad dying in their 40's fr heart disease that I would deff qualify for sleeve, but I am still not sure, but have also been told that most of not all surgeons know whether you are approved or not before they require all the jumping thru hoops. I also meet all Medicare requirements , so am I good to go, yes o very impatient , thanks for any feed back

[fitdrea30 41]

Angierue Have you been approved for December or January?

Edited December 1, 2014 by fitdrea30

[angierue 214]

I was actually approved for November! I was sleeved 11/4. Because my clinic is out of network, I had to pay upfront and will be getting money back but am still waiting to see how much they pay. I'll update when I know exactly how much I was out of pocket!