Who has BCBS and had to do the 6 month pre-op weight loss routine?

[AK37 26]

I am in Kentucky and have Anthem Blue insurance. I have called my insurance several times and keep on getting different answers when I ask about their insurance approval policy for bariatric surgery.

They say they cover bariatric surgery and say that I just need my doctor to say it is medically necessary. All the information given to me about the details of BMI, and weight loss program information varies each time I speak with a person. One person said whether I can get surgery depends on my BMI. Hoping to get details, I asked how. They said that if my BMI is very high then I'd need to lose weight for the doctor to perform the surgery (I think she just made that up, having a very high BMI shouldn't affect insurance approval). I tried to confirm with them the bariatric policy on their website https://www.anthem.com/medicalpolicies/policies/mp_pw_a053317.htm and accidentally gave them the wrong document number and they said: "Yes, that's it." I requested to be sent a copy of the policy and they said: "I can't do that because we don't keep copies of all of the policy info here because the paperwork takes up so much space". Anyway, I have had more productive conversations with my dog.

Has anyone with Anthem Blue had their surgery covered without having to do the 6-month pre-op weight loss routine?

[orionburn 1,024]

I have Anthem and it was required. I don't know if there is any variation between states. My doc's office made it sound like the 6 month program was mandatory with them. Honestly I'd just let your doc's office handle it. They'll know all the ins & outs with the various insurance requirements.

If I recall correctly Anthem requires the following:

1) Must be over a certain BMI (if you actually fall under their mark they won't approve you)

2) If under a certain BMI you must have certain comorbidities that would justify the WLS

3) Must complete a 6 month supervised program

I had a hard time trying to get an answer when doing research on my own. Their website made sleeve surgery look way more expensive than a bypass and/or didn't cover it at all with certain bariatric programs in the area. When I did my first appointment with my doc's office they had the answers I needed. Kind of sad that you'll get more solid info from your doc than the insurance company itself.

Edited January 4, 2018 by orionburn

[AK37 26]

I just got off the phone with a surgeon's office. They said since my primary insurance is Medicare, they think I would not have to go through the 6-month weight loss program. However, that surgeon is out-of-state, and they weren't sure if the same applies to the Medicare policy in my state.

This is potentially good news though

[NewSparky 2]

I just went through similar discussions with various individuals at Anthem Blue Cross in California. I couldn’t get a definitive answer before submitting the paperwork through my chosen surgeons office. Here’s what I discussed with them upon submitting my paperwork: I submitted documentation (details with dates, length of diet plans, location etc.) In my case, I had a gym membership and a personal trainer for 6 months and I had the gym print out my visits. I also had joined Coastal Medical Group, a weight loss office and had proof of that involvement even though I only went once a week for 3 months. They look at duration!!! Even though my BMI was 38, I had high blood pressure and I snored terribly. My insurance approved my Sleeve gastrectomy 11/22/17 and I’m alittle over 6 weeks out. I’m 27 lbs lighter, blood pressure is normal and no more snoring!!! Stay diligent when dealing with Anthem. Call, call, call! Have your surgeons insurance administrator call the people at Anthem who approve the surgery coverage, with you in the office to see if there is any issues with your paperwork. It’s easier to do this than get denied and basically start over. Good luck!

[AK37 26]

I spoke with BCBS this morning. They said I only need a doctor to say that Bariatric surgery is medically necessary; no BMI requirement, no comorbidity, no supervised weight loss.
I'm still waiting to hear back from my local surgeon's office.

Sent from my XT1575 using BariatricPal mobile app

[Tyson4834 59]

I have BCBS and also live in Kentucky. The 6 month wait was mandatory for me but I had to meet with my Nut once a month. The wait for me wasn't an issue as I found it to be very informative. It allowed me to ease into a better diet and relearn how to eat after the procedure. I wouldn't look at the 6 month wait as a "problem" but another tool to ensure your weight loss success.

[poisongirl 3]

I have BCBS and I wasn’t required a 6 month pre op, just the dr approval and a psych evaluation. I had my initial appointment in September and was told I could have it as early as October. I finally decided to get the surgery in December.

[Jerseygirl4523 44]

I have Anthem BCBS in North Carolina and the 6 months are required. 1/2 way there.

Is it 6 visits or 7?