APPROVED - Anthem Blue Cross Blue Shield

[Dorr185 0]

Hello,

I've been reading these boards but this is my first post. I have Anthem BCBS so I thought I'd share my store here too.

So basically, I followed the less is more approach. We sent in 4 pages, a one page letter from my doctor, a one page letter from my pysch, a one page write-up from the nutrition counselor, and one page from the surgeon. Sent it in on the 19th and got approved on the 26th.

I truly think not sending in all the extra paper is why I got approved so quickly. I wouldn't recommend sending in anything they don't ask for. Anthem BCBS PPO only asks for a PCP note, Nutritional counseling (a simple letter will do), and a pysch eval. (a simple letter will do). There is also a form they have for the surgeon to fill out.

It was so quick and easy I was surprised.

[4jin 0]

Dorr185,

I went in for my 1st consult yesterday. The medical coordinator for my surgeon said exactly the same. She said BCBS usually excludes bariatric surgery from their plans, but that when they do cover the service she said it is one of the easiest to submit. they don't require much paperwork other than the basics that you did list on your post. She said if they do they usually just pend it instead of deny ..and they list specifically what they want in order to approve. And once info is sent to them she said they usually hear back within 2 weeks from them.

I got so excited...she told me if all goes well with the testing... we could be submitted to insurance by middle of January and if they approve at inital submital I could be scheduling surgery by February....I am totally psyched now...as I was thinking mostlikely it would happen for late march 2008....!!!!

[Ellisa 6]

4jin,

I hope it all goes as smoothly for you as for Dorr. I attended my nutritian class today. Several of us had Anthem. The same insurance coordinator sent in our paperwork. One went though quickly. Mine took 6 weeks because a couple of pieces were "separated," this happened to others too. Only what was requested was sent. But they requested a couple of things that had already been sent, more than once. So don't hesitate to keep on things at least weekly, because things can go wrong. I don't think it's intentional, more than likely just the mistakes that happen when departments get swamped and/or are understaffed.

[Ellisa 6]

Just a quick update. I spoke to Anthem today and was pleasantly surprised that my out of pocket will NOT be $1500 max but rather $750. ($1500 is for the family, not individual!) Woo Hoo {Caution, this applies to my particular group policy, not to all Anthem policies.)

I'm having my pre-ops on Friday, started low carb liquids yesterday. I'm starving! I had started low carb several days before, just because I thought it would make the transition easier. I lost 5 lbs. doing that. It's so nice to think I may never ever ever see that number on my scales again.

[4jin 0]

way to go Ellisa!!!!!

on both your news on Anthem only $750.....!!!

and on the 5lbs loss!!!

I ordered powders?utm_source=BariatricPal&utm_medium=Affiliate&utm_campaign=CommentLink" target="_ad" data-id="1" >unjury Protein to try out. I should receive today or tomw. I was not given a preop diet but I am going to start my own liquid preop..just to get a head start!

but sshhhh...I'm not starting it until the new year...LOL...

sorry.

hope your hunger goes away...

[dustout 0]

Congratulation Ellisa!! I'm so happy for you! do you have a surgery date yet now that you've started Protein stuff?

I got my first fill last Wednesday but it didn't seem to do much so they gave me another one yesterdat. I'm on liquids until this evening. I can't wait to have more restriction BUT I've lost about 33 pounds now since I started my pre-op diet!! You will love this thing! It's a wonderful tool.

Keep us posted as you go and best of luck with all of it!

[Ellisa 6]

Hello Dustout!

You are doing awesome! Keep it up.

Yes I have a date, the 18th. Pre ops are Friday.

But this liquid diet is tough. I didn't realize I'd be thrilled when there were lumps when I mixed V8 with Protein powder!!! (don't have a blender at work, and too much trouble to deal with if I did)

[dustout 0]

The liquid diet is SO hard! I have to agree with you on that. It sounds like mine was easier than yours though. 10 days before surgery I started mostly liquids with one small meal of solids a day. Then 3 days pre-op I went full liquids. By the time I started more solid foods 2 weeks post-op I was dying for crunchy food or anything that wasn't sweet.

Just hold out until mushy foods! If you like eggs at all you will LOVE them then! You can do a lot with mushy scrambled eggs for variety. It seemed like forever I was on mostly/only Protein drinks. I got so sick of Soups and stuff too. Bleh! I still stay away from anything mushy or soup-like if I can. I think it will be a while until I can like those things again... but I guess that's good for the band anyways.

It may not be the best thing to do for avoiding those cravings for solid food but I spent a lot of time researching recipes for stuff I could cook once I could get solids again and learning better cooking techniques. I want the little food I can eat to taste good. I'm an awful cook still though.

How long do you have to stay on liquids after surgery? Have you found any good Protein Drinks? My doctor requires we use 'New Direction' Meal Replacements during the diet. They have I think 28 grams of Protein. It's a powder you mix with 9.5 ounces of Water. The chocolate flavors are the only ones I can stand though. They remind me of hot cocoa with powdered milk mixed in or something.... it's better than it sounds.

Sorry for the rambling! I'm just so excited to hear about others getting this surgery too. It really does amazing things for people! Well, I better go.

[Lana24 10]

The program fee was $300. It includes the cost of the office submitting required paperwork to the insurance company and one appeal, if necessary, with an attorney. I've heard most places are charging program fees now. It is a little reassuring that there's someone to make sure the i's are dotted and t's crossed before it goes in. I was denied a few years ago, and really never knew exactly why. Right at the time I couldn't deal with an appeal because one of my parents had just be diagnosed with a terminal illness. At least I feel like this time, at the very least I'll have some answers.

I also had to have a psych eval, which insurance might cover. Then there's the suppliments for the 10 day diet and the cost of the dietician.

It's the 12th! Your day is coming quickly!

hey my doc said her program fee is 2800...am I missing something...

[dustout 0]

My doctor doesn't have any program fees... It's all free. It makes me feel a lot better about them too that they don't try to charge fees all over the place. They submit insurance properly and handle an appeal for free which makes sense since if you don't get accepted, they don't get paid. Why should the customer have to pay the doctor to try to get the doctor paid? Oh well. There's not really anything you can do about it if they charge that.

$2800 seems awfully high! Is this refundable if you get denied? Does this include everything you need or something?

Out of pocket I paid: A few $10 copays for the first office visits, $35 after insurance paid for psych eval, $75 for dietician, and lots of money on Vitamins and Protein supplements but I kind of don't count those since it replaces a lot of food too.

[Lana24 10]

Her program fee is to cover the cost of the support group after the surgery.

[Lana24 10]

plus my doc said taking 2 flintstone Vitamins is sufficient

[destiny79 0]

no program fee for me just Doctor visit of $35.00

[Ellisa 6]

Lana,

I guess another good thing about this board with us sharing these types of details is that others can be aware of the differences in charges from facility to facility.

Two years ago when my DH had lap band we went to Barix near Columbus Ohio. They didn't charge a program fee. We knew they were out of network but they told us the total out of pocket would be $1500. The person we were talking to knew that we were concerned about the difference between in and out of network facilities. Well guess what? The out of pocket was around $5K. And the person at the facility who told us that wasn't at their headquarters where the bills come from.

I would guess that the program fees and other fees are creative ways of getting money in addition to what in-network providers have agreed to accept from insurance. But that being said my $300 was worth the peace of mind. And I didn't pay it until they had all my paperwork and said that it looked like there should be no problem with approval based on what I had. I've heard that they have told people that they needed additional info, or probably didn't meet the criteria to be covered. So had I gotten negative feedback, I wouldn't have paid to have it submitted.

Had mine been $2800 I simply could not have surgery there. I can't fork out that kind of money right now. But if I could afford it and it were the only facility I felt comfortable with, I would pay it.

[dustout 0]

Are these places ones that do a lot of these surgeries or do they do other stuff to? Support group is included for life at my doctor for free but then again this is mostly all they do. The support group has about 50 people that go. It's amazing. My doctor does a TON of lap band surgeries and people come from all over to have him do it. The difference might be that the 'bigger' places that do more of these surgeries and more easily afford to not charge a fee since it is so core to their business.

I must say that my doctor's place was definitely the most professional and impressive place I've been. Tons of friendly people that remember your name, hardly any fees, and tons of free classes and access to nutritionists and tons of reading material. I would definitely recommend them to anyone.

It does make me wonder though how many doctors focus their entire business on lap band type procedures rather than doing a mix of things.