Anthem Blue Cross California

[EllaMat13 1]

Hello all! Here is my ridiculous story involving the insurance end of things, and a few questions to follow.

Back in August, I made my first call to start the journey toward surgery. I had UHC at the time and they covered the surgery and required every darn thing on earth, except the 6 month diet prior to surgery. My plan with them was ending 1/31/16 because my employer switched providers. My entire surgical team, along with every Dr I saw during the process knew that I had a deadline. And it seemed like I had plenty of time.

Well, after many miscommunications, ball dropping, wrong fax numbers, etc my surgery was finally scheduled for January 27th. Talk about last minute! Well, to make it even more last minute, as I was being prepped for surgery at the hospital, everything came to a halt. Insurance still had not processed my claim. So they rescheduled me for 2 days later, and then 3 days later-they were willing to operate on a Saturday because they knew what a mess I was in.

Long story short, UHC left the claim as "pending," most likely because they knew my plan was ending and they didn't want to pay for it. Thanks a lot United!

Anyway, my new plan with Anthem Blue Cross California started today. And they require the six month diet. I've been dieting and working out ever since starting this journey, but it hasn't been documented because it didn't need to be. I've seen many posts online about submitting the claim anyway and it being approved without the diet, but all the posts seem to be quite a few years old. Has anyone had surgery through Anthem BC California recently? If so, what was your process like? Did they require the full six months documented diet? How long did approval take? Any information you can give me would be appreciated.

I'm hoping my Dr can explain the situation directly to Anthem and get an approval. This has been the most stressful 5 months of my life!

[jess9395 5,449]

Hello all! Here is my ridiculous story involving the insurance end of things, and a few questions to follow.

Back in August, I made my first call to start the journey toward surgery. I had UHC at the time and they covered the surgery and required every darn thing on earth, except the 6 month diet prior to surgery. My plan with them was ending 1/31/16 because my employer switched providers. My entire surgical team, along with every Dr I saw during the process knew that I had a deadline. And it seemed like I had plenty of time.

Well, after many miscommunications, ball dropping, wrong fax numbers, etc my surgery was finally scheduled for January 27th. Talk about last minute! Well, to make it even more last minute, as I was being prepped for surgery at the hospital, everything came to a halt. Insurance still had not processed my claim. So they rescheduled me for 2 days later, and then 3 days later-they were willing to operate on a Saturday because they knew what a mess I was in.

Long story short, UHC left the claim as "pending," most likely because they knew my plan was ending and they didn't want to pay for it. Thanks a lot United!

Anyway, my new plan with Anthem Blue Cross California started today. And they require the six month diet. I've been dieting and working out ever since starting this journey, but it hasn't been documented because it didn't need to be. I've seen many posts online about submitting the claim anyway and it being approved without the diet, but all the posts seem to be quite a few years old. Has anyone had surgery through Anthem BC California recently? If so, what was your process like? Did they require the full six months documented diet? How long did approval take? Any information you can give me would be appreciated.

I'm hoping my Dr can explain the situation directly to Anthem and get an approval. This has been the most stressful 5 months of my life!

I had my surgery through them but it was late 2013. I didn't have to do any diet just provide evidence of past attempts (my GP did that but if you have weight watchers records or something like that it would have worked too).

[2goldengirl 2,076]

Here is a link to Anthem's medical policy: https://www.anthem.com/medicalpolicies/policies/mp_pw_a053317.htm

"The individual must have serially documented active participation in a non-surgical weight reduction regimen for at least 6 continuous months, in the 2 years prior to surgery, to enable both behavioral changes and adequate assessment of anticipated postoperative dietary maintenance. These efforts must be fully appraised and documented by the physician requesting authorization for surgery;..."

So it's six months within the past two years. If you have that, you're good.

And a tip: it isn't a claim until the service is provided; beforehand it's a request for authorization before a decision is made, an authorization once it has been approved.

Good luck!

[asharati2016 1]

I began the weight loss surgery song and dance with Cigna. They required four visits with a nutritionist before they could submit. With one last visit, the job switched insurance carriers and we ended up with Anthem Blue Cross California. I was in limbo while I waited to see what the new requirements would be.

After a month of waiting, I find out all I needed was one visit with nutritionist.

They submitted my paperwork and eight days later I had an approval and a surgery date two weeks later.

The process went smoothly and better than I could have anticipated.

[EllaMat13 1]

I began the weight loss surgery song and dance with Cigna. They required four visits with a nutritionist before they could submit. With one last visit, the job switched insurance carriers and we ended up with Anthem Blue Cross California. I was in limbo while I waited to see what the new requirements would be.

After a month of waiting, I find out all I needed was one visit with nutritionist.

They submitted my paperwork and eight days later I had an approval and a surgery date two weeks later.

The process went smoothly and better than I could have anticipated.

Well I just found out Anthem CA doesnt require a pre-certification, but my Dr submitted one for approval today anyway. Do you think the Drs require it so they are sure they will be paid? I know with Medicare, for example, there are no pre certs, but you have sign a doc saying you'll pay any charges that aren't covered after surgery. Ugh! so nervous! how long ago was your surgery?

[asharati2016 1]

I began the weight loss surgery song and dance with Cigna. They required four visits with a nutritionist before they could submit. With one last visit, the job switched insurance carriers and we ended up with Anthem Blue Cross California. I was in limbo while I waited to see what the new requirements would be.

After a month of waiting, I find out all I needed was one visit with nutritionist.

They submitted my paperwork and eight days later I had an approval and a surgery date two weeks later.

The process went smoothly and better than I could have anticipated.

Well I just found out Anthem CA doesnt require a pre-certification, but my Dr submitted one for approval today anyway. Do you think the Drs require it so they are sure they will be paid? I know with Medicare, for example, there are no pre certs, but you have sign a doc saying you'll pay any charges that aren't covered after surgery. Ugh! so nervous! how long ago was your surgery?

I had my surgery on February 9 and everything went well. No complications and for that I'm grateful!

I do know doctors have to submit for approval by the insurance. I've heard of some people being denied so I don't think it has to do with doc's being paid...more so about really needing the procedure!

I think everyone is a bit nervous before surgery but once it's done you're glad to be on the other side of it.

Good luck!

[Deletemyacct 39]

I have bcbs-ca What I'm reading online is not what I'm told when i call. It seems all i need is proof of obesity, surgery is medically necessary & get pre-authourized. I'm going to a uhealth seminar on Tuesday & hope all goes well. I'm praying I don't have to wait six months

Sent from my LGMS631 using the BariatricPal App

[Epo-VSG 3]

I have anthem BC of Cali and used 4 months of visits with my endocrinologist for my diabetes, where she recorded my weight every visit, then I did two visits with the Nutritionist. Anthem approved within 5 days of receiving my medical records. Do you have any consecutive 6 month period in the last year where a medical professional (or a few) recorded your weight monthly? That should be all you need.