Anthem BC/BS in VA - any experience or advice?

[O2BThinAgain 0]

I had my first appointment yesterday. The dietician and the surgeon feel that I should not have any problems, however another dietician was quiet pessimistic. :cry She doesn't think I'll be approved....maybe she's just being careful. I don't know!?!?! My BMI is 39.7, with 99 pounds to lose. I do not have hypertension or diabetes, but my cholesterol is a little high, but not considered dangerous. I have joint problems though (2 knee surgeries on left knee), a herniated/a protruding/a bulging disk(s) in my upper back and incontinence. I was psyched until the last lady saw me. I work at the hospital that does the surgery, so maybe that will help. I'm in Virginia & I have Anthem BC/BS Choicecare/Blueview. I really, really want this badly!!!! My knee is starting to bother me again and I'm tired of being a load & having my upper back hurt. Also, I can't stand having "hidden areas", if you know what I mean!!! Any words of wisdom, encouragement, advise would be most encouraging while I wait!!!!

[SuzanneG 1]

My BMI was 35.1 when I first started trying to get approved. I got denied because I didn't have heart disease, lung disease or sleep apnea. By the time I wrote my appeal letter, I had gained a few pounds and my BMI was 36.7.

I had to write a letter of appeal to BCBS. I wrote a letter of medical need, then a letter of emotional need, then I gathered letters of support from my GP, GYN, Podiatrist, and Gastrointerologist. Then my bariatric surgeon sent the entire package through with his endorcement.

BCBS called me directly and said my letter was amazing and that they decided to approve me.

If you have to appeal, I'd be happy to share my letters with you, just post your email and I'll send them to you directly.

Good Luck!

Suzanne

[O2BThinAgain 0]

SuzanneG,

Thanks for the info! I found out today that I'm approved! I appreciate your offer. I see that your date is only 2 days away!!! Good luck with your surgery and please keep me posted on your progress/feelings/etc.

[SuzanneG 1]

Congrats! I'm 8 days out and doing OK. It was a hard week, but I think I'm over the hump.

[O2BThinAgain 0]

Glad to hear things are going ok for ya! My date isn't until 3/11. I'm really looking forward to it. I have just about the same amount of weight to lose as you do, so it'll be neat to hear how you're doing! I've started back to working out so that I'll be a bit ahead of the game by the time surgery comes around. Keep me posted & congratulations to you too!

[parrot0927 0]

Congrats O2BThinAgain! I have Anthem. I had my doctor appts on 11/5 and was approved on 11/8. My surgery was on 12/3. It was well worth it.

I believe that Anthem is realizing it is cheaper for the folks to have the surgery and get healthy than to pay down the road for the health problems associated with obesity.

[O2BThinAgain 0]

Wow!!!! You've lost 29 pounds in a month! Great job! You must be so proud of yourself!!!

I'm having my procedures done at MCV with Dr. Kellum. I'm extremely pleased with my insurance process. I had documented all of my weight loss/dieting history, any health issues, I had routine blood work performed 2 months prior to check cholesterol/glucose/thyroid (which I had never done before), etc. So, they apparently had all of the info that they required and handled the processes effectively.

You're absolutely correct, in that this surgery will reduce the chances of having other health complications in the long run. Which, in turn, will reduce the chances of having to need other procedures, etc.. That's the goal here, well....other than to look & feel great too.....which helps the mental health also in the long run!!!!

Gosh, I can't wait to SEE the real me again! It'll be very cool!

[larabee64 0]

I have insulin resistance, hi cholesterol and triglycerides, hypertension, and a few other ailments. I am interested in the lap band but don't think my family dr will agree. Just saw info on the news about the lap band and diabetes and it gave me a bit of hope. I am located near Roanoke, does anyone have a recommendation as to a dr in the SW area to see. I am new to this, so any advice will help.

[O2BThinAgain 0]

Sorry, I don't know of any doctors down your way. With your coverage, do you need to have a referral from your doctor? If not, you can go straight to the Bariatric/Gastro doctor yourself. If you doctor doesn't want to give you a referral I'd think that, unless your doctor has documented & specific reasons why you shouldn't have a referral, you should be able to tell them that you want the referral regardless if they like the idea or not. That's what WE pay insurance for! Is your VA Anthem with Blue Cross & Blue Shield? Do you have the PPO option showing on your card?