Anthem BC/BS needing Documented Medical History

[MellyBean 0]

Hi everyone! I'm new to this website, but have been looking into the lapband for 7 months now. I recently got a new job with American Medical Response and now have Anthem Blue Cross Blue Shield PPO. I've been in touch with a few different Surgery Facilities, all saying that I will need documented medical history from a physician. One company said 6 months history, another said 3 years. My problem is that I've never had medical insurance before, therefor I haven't seen a Dr. since I was 15 years old. (I'm 25 now) Do most insurance companies want proof that you've actually seen a physician for 6 months to 3 years regarding weight loss? Or are they just looking for a physician to document a person's stated struggles and trials with weight loss? I'll be in touch with my insurance company tomorrow to find out for sure what their criteria are. Anyone have expereince with Anthem BCBS, by the way? Thanks so much!! I'm really hoping for the lapband. I know in my heart it's the best approach! :clap2:

[MellyBean 0]

I just got off the phone with Anthem BCBS, and like Tigerlily, I was told that WLS was excluded, at least from my policy, anyway. That's discouraging, as I did a lot of research on Anthem BCBS and found so many people who had used it to have the lapband done. I didn't think about finding out whether my employer excludes it. Such a shame.

[Ozzy&OdiesMommy 0]

I just called Anthem today and found out that any bariatric weight loss surgery is excluded from my policy. Is it the employer that determines if its excluded or not? Just wondering.

Thanks!

[MellyBean 0]

Hi Ryan.

I had enrolled in the Anthem plan over the Kasier option because of all of the people I had read about who had bariatric surgery covered by Anthem BCBS. After a lot of phone calls and questions, I discovered my EMPLOYER actually excluded weight loss surgery from our anthem policy. From what I hear, there's not a lot one can do at that point. Though, I think I heard one story about a woman getting past her written exclusion with obesitylaw.com.

After I found out about my employer's written exclusion, I got on my knees and PRAYED for God to provide a way. :faint: lol Then something AMAZING happened! I called the benefits department at work, and asked them about our Kaiser plan. My employer had NOT excluded weight loss surgery from Kaiser. WHY they would exclude from one and not the other, I have no idea. So I asked when open enrollment was and they said it was in about 8 months. But come to find out, the window that HR had opened for me to enroll that was supposed to close WEEKS ago had remained open....which they couldn't explain. So they let me switch right there on the spot. How AMAZING is that? That's unheard of...at least to me. :clap2: I'm so excited! Then, a new gal started working in my department. She was actually a rehire as she worked there for 7 years but left 3 years ago and decided to come back. She and I just got to talking and she told me she had gastric bypass. She had it done while working for our company and had KAISER through work. I'm tellin ya....there are no coincidences.

I really wish you luck Ryan. Don't get discouraged! I know it's cliche, but when there's a will there's a way. I even considered looking into possibly enrolling in my own private secondary coverage, hoping to have it paid for or at least partially paid for. Find out if there's another insurance company your employer offers....if there is, find out if there's a written exclusion through that one. If there isn't, JUMP ON IT when open enrollment comes around. Don't give up!

[Ozzy&OdiesMommy 0]

Thanks for your reply. I feel so hopeless right now. I am in the foulest of moods. I just don't know that I am going to have another option like that. My hubby's company only has Anthem coverage. I feel like I've been kicked in the chest. I finally made this monumental decision to try and move forward with WLS and then this! There is no way that I can pay out of pocket for it. That's what is so frustrating. Do they want to pay for me to have a heart attack. It just makes no sense.

Ok, enough of the pitty party. I need help with what my next move is. Any advice would be SUPER!!

Thanks so much!

[amanda2008 0]

I know... it is absolute bullshit. I have a back problem (actually dislocated pelvis) and can't exercise until it heals. Of course my weight is preventing it from healing.

Yet can you imagine how much back surgery + disability would cost them???

[Ozzy&OdiesMommy 0]

I honestly think the would just as soon have us die! But that's a really bad attitude to have. So enough of that! I just hope I can get some ideas on how to either get insurance to pay this or another way of paying for it! I just feel like I have no other options left. I'm so sick of the yo yo. Its not healthy. I loose a weight and then I gain it back plus some. Its just time for it to stop.

[amanda2008 0]

our health care system is ridiculous.

I'm going to have to ask to borrow money or have someone co-sign a loan with me. I guess I'll go to Mexico and get it done at half the cost.

[Ozzy&OdiesMommy 0]

My husband would NEVER let me go to Mexico! He's too worried I'd die! He won't sign the back of his license for organ donation becase he thinks they will kill him for his organs. Geez!

[Vicki J 0]

Ryan - Why don't you get your doctor to write a compelling letter about your health issues and you do the same. Take them to your husband's employer (or he can) and see if they will lift the exclusion. I have heard of one person who got this done. If they don't then I would contact obesitylaw.com. I have heard they won't charge unless they feel they can win but they give free advice. I'm not sure but that's what I have heard.

Melanie222 - Congratulations!!! What a score on your part. I am also going through Kaiser in northern California. Where are you from. The Kaisers in northern California are sure overwhelmed by all of the people getting WLS. They just keep getting further and further behind. It's a long journey but it will be well worth it. They have me on a "pre-op meal plan" (1200 cal. diet) to shrink my liver and such. You loose pretty good on it and I feel that I have to loose it anyway and I have their guarantee that I won't be kicked off the program if I loose too much so I just keep working on it. I look at the band as something to not only help me loose weight but to also help me keep it off.

Once again...congratulations!!!