Anthem BCBS denied my surgery [emoji22]

[Flo-grown 194]

My surgery is already scheduled for July 31st. I received a letter from my insurance company, Anthem BCBS on Friday denying my request for my sleeve surgery. They claim I have not met all my requirements which I have. I've been under my surgeon's care since December. I have met all my surgeon's requirements. BCBS is saying I have not been on a supervised diet for 6 months. I plan to appeal their decision but this could not have happened at a worse time for me. I just found out I have 60 days to move!! Its been very stressful the last few days. I'm super bummed and feeling frustrated and overwhelmed by everything [emoji24]. I've worked so hard to come this far and to get all of this bad news at once. I'm praying everything works out as it should. I'm so depressed.

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[Sosewsue61 3,185]

Have you been on a supervised diet w the bariatric nutritionist? If you have then someone did not submit it properly. Did they have a diet plan?Record your weigh-ins? And your progress?

Did they submit monthly? There are rules that insurance has on when submissions need to be done - if the surgeon's office did not do this then they have some explaining.

Take a deep breath. Talk to the insurance submission person at the bariatric clinic - and have them CALL BCBS and talk to the intake person there and find the issue. Do this in person at the bariatric clinic - not on the phone - the surgeon's office will be very motivated to get it corrected. At the worst your surgery could get delayed.

In the meantime, carefully follow the appeals process. Be diligent in following up with the corrected submissions.

[Flo-grown 194]

Yes, I had monthly visits with my surgeons office for weigh ins and to discuss my diet and exercise goals. I also seen a bariatric nutritionist my surgeon recommended on a few occasions. I followed all of the instructions I was given. Due to my ongoing medical issues and hospitalizations, I have been in the covered phase of my insurance for a couple of months. I plan on speaking to my surgeons office Monday morning and filing the appeal. It's just disheartening to come so close and having a date finally then getting the bad news. Plus all of the other things I'm having to deal with. I'm so overwhelmed.

[thillman1987 43]

Yes, I had monthly visits with my surgeons office for weigh ins and to discuss my diet and exercise goals. I also seen a bariatric nutritionist my surgeon recommended on a few occasions. I followed all of the instructions I was given. Due to my ongoing medical issues and hospitalizations, I have been in the covered phase of my insurance for a couple of months. I plan on speaking to my surgeons office Monday morning and filing the appeal. It's just disheartening to come so close and having a date finally then getting the bad news. Plus all of the other things I'm having to deal with. I'm so overwhelmed.

Keep your head up. They will figure it out. I have BCBS and the denied me as well. They said it was because I haven't quit smoking for over 6 months. If it gets pushed back it's going to be a pain I understand but don't let it dishearten you because then the insurance company will win and not have to pay for it. I'm sorry it happened to you but don't let this speed bump ruin your whole ride.

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[Flo-grown 194]

Thank you, I not going to give up this easy after all the money and effort I've invested. Its just sad and frustrating to have to jump through all the hoops but I know I need to and it will be so worth it!

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[TattooedSeaStar 139]

4 hours ago, Flo-grown said:

Yes, I had monthly visits with my surgeons office for weigh ins and to discuss my diet and exercise goals. I also seen a bariatric nutritionist my surgeon recommended on a few occasions. I followed all of the instructions I was given. Due to my ongoing medical issues and hospitalizations, I have been in the covered phase of my insurance for a couple of months. I plan on speaking to my surgeons office Monday morning and filing the appeal. It's just disheartening to come so close and having a date finally then getting the bad news. Plus all of the other things I'm having to deal with. I'm so overwhelmed.

I have BCBS as well but I was told my 6 months had to be with someone other than my surgeon. BCBS of GA doesn’t cover at all, but my husbands company is out of another state which DOES cover (PTL!)... don’t know if this is an insurance requirement or something my surgeon requires.

[Flo-grown 194]

I have BCBS as well but I was told my 6 months had to be with someone other than my surgeon. BCBS of GA doesn’t cover at all, but my husbands company is out of another state which DOES cover (PTL!)... don’t know if this is an insurance requirement or something my surgeon requires.

I should have been made aware of this from day 1. Hopefully my surgeon will know more about it on Monday. I'm praying it's something minor.

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[TattooedSeaStar 139]

13 minutes ago, Flo-grown said:

I should have been made aware of this from day 1. Hopefully my surgeon will know more about it on Monday. I'm praying it's something minor.

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Agreed! I hope you find your answer!

[WeeDee 6]

My InsuranceRequired me to see a nutritionist for three months. If I would’ve missed one of the appointments then I would’ve had to start all over. So maybe they wanted you to see a nutritionist for six months in a row? I would ask the insurance company exactly what they want you to do

[ZGal 84]

I had to do six months of supervised nutrition prior to being approved for my surgery. It had to also be with a nutritionist, it could not be my surgeon. And they had to document all of my visits and what we talked about and my weight, and submit it to insurance. If I had more than 30 days in between nutrition visits, my insurance would have started my nutrition journey all over. Prior to even starting my Weight loss journey, I looked up ANTHEM BCBS’s requirements, and I also called them to doublecheck and make sure that something like this would not happen. I’m sorry that you had to go through that, HOWEVER, The upside to it is you can start your nutrition journey now and then you will have met all the requirements.