BCBS Anthem Insurance approval

[slimmingup38 0]

Excited and nervous! Just received the call from BCBS Anthem advising that VSG surgery was APPROVED! It was submitted on 1/21/15 and approved today 1/26/15 3 DAYS!!!! The contacted me by phone to advise that the surgery was approved and informed me that I will be receiving an approval letter in the mail with the next 5-7 business days. The also advised that the approval letter was faxed over to my doctor's office. I was provided a approval reference number as well if I needed to callback before receiving the letter. I was informed that they also provide Bariatic Case Mgmt thru my plan at no cost and a Nurse Case Manager will be contacting me in the next few days to assist me with the process. Now the downside..... I have to pay a $1500.00 deductible, $300.00 coinsurance and 30% of total charges with a out of pocket max of $5000.00 which means I will not pay over 5000.00 for all services. Now I have to meet with the surgeon to schedule a date.

[melodyssss 30]

Congrats! I had BCBS of Illionis and they approved me quickly too! How exciting! Best of luck to you. Keep us posted when you get a surgery date!

[Ladiec2 74]

Wow…the exact same thing with me. My paperwork was submitted to the insurance company on 1/21/15 as well and got my approval date today! I am solo excited. Congrats to you.

[SarahLovy 6]

How long of a pre-surg diet did they require you to do?

[AhnaLucille 57]

Congrats on the quick approval. Hopefully you've been saving up some. I'm worried about out of pocket expense myself.

I hope everything works out for you and you get your date soon.

Best of luck!

[bvenegas 89]

Congrats!!!!! I have Anthem BCBS California and my paperwork was submitted yesterday, so just waiting anxiously. Do you have HMO or PPO?

[PearlyQ 0]

Excited and nervous! Just received the call from BCBS Anthem advising that VSG surgery was APPROVED! It was submitted on 1/21/15 and approved today 1/26/15 3 DAYS!!!! The contacted me by phone to advise that the surgery was approved and informed me that I will be receiving an approval letter in the mail with the next 5-7 business days. The also advised that the approval letter was faxed over to my doctor's office. I was provided a approval reference number as well if I needed to callback before receiving the letter. I was informed that they also provide Bariatic Case Mgmt thru my plan at no cost and a Nurse Case Manager will be contacting me in the next few days to assist me with the process. Now the downside..... I have to pay a $1500.00 deductible, $300.00 coinsurance and 30% of total charges with a out of pocket max of $5000.00 which means I will not pay over 5000.00 for all services. Now I have to meet with the surgeon to schedule a date.

Slimmingup38, congratulations on the quick approval. Did you have to complete 6 months of diet/nutrition supervision before BCBS Anthem would approve you?

[AmyFromCincy 56]

Im with that company too so im happy to hear this

[readinva 10]

I'm with Anthem BCBS. Paperwork submitted 2/2 and my doctors office called 2/3 and said I was approved! One day! I couldn't believe it!i only had to have psych eval, clearance from my GP and BMI of at least 35. It was the easiest thing ever!

[GADeltaDawn 14]

Hi, I have anthem BCBS also and was curious if anyone knows what the negotiated rates are? My doctor gave me the self pay cost but they said the insurance company will only pay based on their negotiated rates which could be as low as half that amount. I'm really trying to find out how much I'm going to need. I'm only responsible for 25% of the negotiated rate with no deductible and a max OoP of $3000 for everything.

[SarahLovy 6]

Hi, I have anthem BCBS also and was curious if anyone knows what the negotiated rates are? My doctor gave me the self pay cost but they said the insurance company will only pay based on their negotiated rates which could be as low as half that amount. I'm really trying to find out how much I'm going to need. I'm only responsible for 25% of the negotiated rate with no deductible and a max OoP of $3000 for everything.

It depends on the agreement between the hospital/doctor (or their negotiating entity) and the insurance company, and it varies a lot. The negotiated rate for my son's ear tubes was almost 90% of what was billed, but for my c-section it was only about 30% (different hospital system). There is a place on Anthem's website where you can look up the estimated cost of a procedure at a given hospital- some places aren't on there, but you can get a general idea. I personally am just assuming I have to pay my OOP max of the year (I have a $2000 deductible, then 80/20 coverage with an oop of $6k).

[gettingfit2015 0]

That's the insurance I have too. Did you have to do any waiting period?? (And congrats!)

[GADeltaDawn 14]

That's the insurance I have too. Did you have to do any waiting period?? (And congrats!)

I didn't have a waiting period or a supervised diet. I'm still preop and had everything done within 3 weeks. I'm just waiting on my dietician appointment and then I'll get my date.

Edited March 3, 2015 by GADeltaDawn