APPROVED - Anthem Blue Cross Blue Shield

[dustout 0]

I got approved about a month ago but I figured I would let people know in case anyone else wonders about things with this insurance.

I have Anthem Blue Cross Blue Shield PPO. It took about a month before I was approved. They claimed they were very behind for some reason so it took longer than normal. I only had to show some kind of proof that I attempted other weight loss methods and failed. In my case this included a life long history of up and down diets and I tried phentermine for a couple of months.

They are also going to cover the assisting surgeon and the Lovenox injections after. They approved me for same-day outpatient (unless of course there's a complication).

Hope this helps someone at some point! Surgery date is October 15, 2007!

[Ellisa 6]

Congratulations! The 15th! Wow!

Which state is your policy with? I have Anthem PPO, with Ohio. I was told by my surgeon's office to allow 4 - 6 weeks for approval, it was sent in this week. My surgeon is already booked through the end of November so it will be after the first of the year at the earliest. I had hoped for sooner, but hey.

Again congrats to you!

[dustout 0]

I'm in Oklahoma but we always mail payments and stuff to Anthem in Conneticut. I also have PPO.

Either way, Anthem itself has a main policy on Lapband which they created early this summer. Here is the link on what is required to be banded under anthem:

http://www.anthem.com/medicalpolicies/noapplication/f4/s10/t2/pw_034084.pdf

This is NOT state-specific. It's extremely informative.

It took me about a month for insurance to reply. However, my surgeon only had expected about a week or two. I called insurance and they told me "We're about a month behind". Anyways, I hope you find out soon and good luck with surgery! I'm excited! Only a few more days to go...

[Ellisa 6]

Thanks for the information. The site is informative. I'm hoping I don't have to do the 6 months supervised weightloss. I too have a long history, but most of it not physician documented. Seven years worth of my medical records are MIA. ARRRRR Happened when my doc changed practices, he didn't take them but the former place claimed he did. Regardless, I don't have them. During that time I was using Merida and Redux.

Please keep in touch so I'll know how things go for you. I know you must be so excited you can't sleep!

My husband was banded two years ago. I can't tell you what a difference it has made for him. He used to be so tired all the time, now I can't keep up with him.

[dustout 0]

Ironically most of my diet related records were lost too... the doctor's office changed filing systems and lost a ton of stuff... my only record of the prescription diet pills is I have my last prescription bottle but they never asked for it.

My doctor told me that although Blue Cross Blue Shield usually requires the 6 month diet, ANTHEM Blue Cross Blue Shield doesn't so hopefully that will apply too. It's really confusing about all the insurance stuff. I really hope some day it all changes so it isn't so confusing and such a mess. It's definitely not set up to make it easy for the patients to know what's going on or will be required of them. The term 'medically necessary' gives them loopholes too in my opinion.

[Ellisa 6]

Dustout,

Oh my it's the 11th already. You are just a few days away!

Your posts are so encouraging. You seem to have so much in common with my insurance issues. The office manager at my doc's office seemed optimistic and she's supposed to know these things... but there's this little piece of me that wonders... what if they tell everyone that just to get the "program fee?" Isn't that just horrible of me? I think it's the result of being denied 4 years ago (Med Mutual then) after believing it was going to be approved (different facility, too). I want to believe, but...

Please post as soon as you can afterward, I'll be looking forward to hearing about how you get along.

Donna

[dustout 0]

How much was your program fee? I've heard of others here having that but I didn't have one. The only things I've had to pay out of pocket were seeing the nutritionist, psych eval (insurance doesnt cover), and for Meal Replacements for the 10 day diet.

I'll definitely post updates. I'll try to post once I'm back from surgery if I'm half-way sane after all the drugs.. :Banane30:

[Ellisa 6]

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!

[dustout 0]

I was banded yesterday! I had horrible nausea after I woke up from the anesthesia and pretty much all day. It was AWFUL. I wasso miserable from that. They kept giving me stuff to stop the nausea but then I was so drowsy that I felt like crap.

HOWEVER, today I feel awesome. 95% nausea free (just a little if I walk right after taking pain meds) and very little pain. Just feels like I got hit in the stomach or ran my stomach into something like the edge of a table. The pain is definitely not a problem. When I'm on the pain med and not moving, I feel zero pain at all. I pretty much feel normal, just a little gassy.

Let me know how your surgery goes when it's time! I'm cheering for you! If you get nausea from anesthesia be sure to let them know so you can head that off. We didn't know for me since this was pretty much my first surgery besides tonsels. They figured the tonsels nausea was just from drainage.... it wasn't though...

[Ellisa 6]

Glad to hear it went as well as it did. I'll watch for your posts on other forums now that you're in the "big league;" quickly becoming one of the lean, but not mean.

I also have issues with nausea following surgery. No, it's not just nausea... I usually toss my Cookies for a few days. So yes, I will make sure they know going in. I have a way to go, my stuff just went to insurance last week.

[parrot0927 0]

I'm glad to see they covered yours. I work for Anthem in VA. I had read my coverage many times. I went and spoke with the case managers/RNs just to make sure that I was reading it correctly.

I appears that mine will be covered too. I just need a referral from my PCP, psych visit, etc. I can't wait!

[katiep2003 0]

I am so glad to hear that Anthem is covering the surgery. My husbands employer is switching us over to them. Does anyone know how longI will have to wait before I can start the process?

Thanks

[Ellisa 6]

KatieP,

Most of the time insurance through employers don't have an issue with pre existing conditions. But companies can choose to exclude bariatric surgery on their individual policy. In other words, one person's employer may have Anthem and cover the surgery, the business next door might have an exclusion. It's less expensive. Smaller companies are more apt to have the exclusion. Call the number on the back of your card and ask the customer service representative.

[katiep2003 0]

Ellisa - Thanks, I guess I have to wait until we get all the stuff, it doens't officially switch until Nov 1st. I hope that they don't have the exclusion. Because I so cannot afford this surgery on my own and REALLY want it.

[Ellisa 6]

I'm having a terrible horrible very bad day.

I called my insurance co. last week and they said they hadn't received anything although my doc's office said it was sent in the week before. So I called back today and again the ins. said they hadn't received anything. So the doc's office called them and they said yes they had it but they were so far behind they hadn't had a chance to look at it. Over two weeks and they don't have time to look at it and even update their database that they have it? What kind of crap is that? ARRRRRRRRRR