Anthem BC of CA Shenanigans

[Sumaire 75]

Just heard from my Surgeon's staff today that ABS has raised the goalpost and is now requiring a TWO YEAR monitored group nutrition program before they'll approve GBS.

They also say that IPA hasn't approved ANY of their requests since the first of the year.

Any suggestions? I could be dead in two years, with my comorbidities combined with a BMI of nearly 50, if I don't have this surgery.

Sent from my iPhone using the BariatricPal App

[Sumaire 75]

They seem to be going with the second example given, rather than the first one. Leave to them to be far more restrictive.

• The recipient has failed to sustain weight loss on conservative
regimens. Examples of appropriate documentation of failure of conservative regimens include but are not limited to:

Severe obesity has persisted for at least five years despite a structured physician-supervised weight-loss program with or without an exercise program for a minimum of six months.

Serial-charted documentation that a two-year managed weight-loss program including dietary control has been ineffective in achieving a medically significant weight loss.

[Sumaire 75]

Spoke with ABS and LACare (who I have my insurance through, ultimately), and they have said that the two year requirement is bogus (not their words -- I'm paraphrasing).

They are having me have my surgeon's office submit a request and if/when it's denied, promptly filing a grievance to get this resolved.

Weird (but nice) when the insurance folks are actually TRYING to help you.

[Whitefoot 14]

I hired Lindstrom and they were able to speed up my wait for surgery. I only had a 6 month wait but they got that cut in half.

[Sumaire 75]

Called my doctor's office a couple minutes ago.

"Your ears must have been burning, we were just talking about you."

Seems that Preferred IPA gave them a call this morning to tell them that they are working on a LOA (whatever that is) right now.

I guess my phone calls must be having an effect on things.

[Marissa.Ann.C 21]

Hope this gets resolved! Based on these boards it seems like anthem BCBS is a real pain in the ass I have it too

Sent from my iPhone using the BariatricPal App

[Sumaire 75]

I ended up having to change medical groups under Anthem Blue Cross from Preferred IPA to AltaMed. At least with AltaMed, they're actually willing to speak to patients, unlike Preferred IPA.

At this moment in time, I am waiting for, and praying for, an authorization to go ahead with my surgery. My new surgeon sent in that request on Monday.

As you can well imagine, I have been able to think of little else in the ensuing days.

I hate waiting.