Anthem BCBS OH please help

[Leesa926 72]

So my insurance was submitted and after numerous calls I keep getting the run around first then told that there is no requirements as far as 3 months or 6 months my surgeon's office made me complete a 3 months.

Everytime I call they say there's nothing specific listed just all the information to see if it would qualify

I now found out that it is pending further information as on the phone they told me they didn't have information. The letter I have almost it is as if they have nothing. It states diagnostic testing results previously tried treatments and any other information you feel would support the request

In the paragraph they talk about BMI and weight reduction regimen for at least 6 continuous months in the two years prior to surgery. These efforts must be fully appraised etc. I know they have my weight watcher records and I was told that's all that they would need plus I sold my other position regarding phentermine. I am hoping they just wanted to say that I have tried for at least 6 months not under doctor's supervision like some of the plans say.

Now I am scared that I need 6 months rather than 3 months. My plan was printed out at the surgeon's office and this is not what it said other Blue Cross Blue Shield do say that.

Can anyone tell me if they feel I'm going to have a problem? Surgeon and insurance are both closed until Monday so I have to wait at least until then my fear is that next year the insurance will go up considerably

Thanks in advance I am sort of freaking out

It does show it like this >bmi, 6 months, so I'm hoping they mean in addition to that meeting they already have that information. When I called on the phone they said they were just missing with the facility information but that is not shown on the letter

[Leesa926 72]

Think I found a silver lining it says six continuous months not consecutive is that right? Fully appraised doesn't necessarily mean under doctors care. Hope I'm not just pulling at straws

[fernandfj 469]

BCBS is difficult to deal with - at least it was for me. I submitted alt the necessary information per their brochure. I was then asked for more information and when I questioned it they said they would review again. It took a month, but then they turned around and approved (It was the federal BCBS program). It's so confusing that you have no idea what is needed - which I think is the plan all along. I stuck with it and prevailed, but it was not easy and frustrating.

[Leesa926 72]

Thanks just hoping my doctor's office had it right they said all along I was within the requirements.

[Suers1019 6]

I too have Anthem Blue Cross. Your post scares me as I planned to have my surgery in March but my employer is switching to Medical Mutual 1/1/16 and they do NOT cover this surgery. Had to speed everything up. My last (#6) primary care appt is 12/1 then my surgeon will request for approval. I have a 3 week window to get approved and get my surgery. I am praying they move quick!

[Tssiemer1 549]

Oh crap. Now I'm freaking out. This is my insurance. My husband works at Anthem as well. I don't have weight watcher records. In my "6 continuos months in 2 years" I did weight watchers for 2 months. It was too expensive so I changed to slim fast. I have medical records and weigh ins at doctors office showing I lost weight during that time. I called the doctor and got all my weigh in from the past 2 years and put that with my 6 month diet info.

I hope that's enough.

I started this journey in September so I'm already 3 months in on this pre - pre op diet. So I guess it's not so bed.

Idk. I'm just freaking out.

Edited November 28, 2015 by Tssiemer1

[Leesa926 72]

When might doctors office said I didn't need 6 months so I've done three months with him I just don't have medically supervised I think its just saying that he has to approve that you've tried to lose weight I don't know. My practice is pretty big I can't imagine they wouldn't have the right information

[misswinnie 2]

I have federal bcbs and I just got rejected because it requires weight history for 2 years. Unfortunately I didn't need to see a dr in 2014. I have records for 2013 and 2015. So I'm kinda stuck at the moment as to what I should do. Was so excited but now I'm deflated. ????

[Tssiemer1 549]

That's how I felt when I found out I had sleep apnea.

I was tentatively scheduled for last Monday.

Took the wind right out of my sails.

[misswinnie 2]

I was diagnosed with sleep apnea too. Had no idea. Smh And hiatal hernia. I thought I was just having digestion problems, now I know the cause of it.

[Leesa926 72]

Here is what the letter says. It's almost like they send a blank file..

They have said on the phone numerous times it does not state needs 6 months as well as the paperwork so hopefully this is just a "suggestion" of what to send.

So annoyed surgery was requested for 12/9 so hopefully I can still get this year.

Any insurance gurus to put my mind at ease. Thanks

[Leesa926 72]

Before that part it says in order to process the following is needed.

[misswinnie 2]

Aww man, I wonder if the insurance company have changed requirements recently and maybe the dr didn't get notified. Hopefully you can keep your day. Good luck!!!

[Leesa926 72]

Even when I called wed they said there was no specifics so hoping that's just a guide. The woman over the phone said yes some states/plans require yours does not. Seems they didn't get anything on my file sent over. Tomorrow I will know more...hopefully!

[misswinnie 2]

Oh ok. Fingers crossed!!!