Anyone with Anthem BC/BS PPO in Ohio?

[kdlee 0]

I have my initial meeting with the surgeon in a week. I called my insurance company and asked about coverage. According to the website and their on-line policy, there is no specific time frame that you must have been on a medically supervised diet. I thought I would go ahead and ask anyway, and I was told by the insurance rep that she wasn't sure and she guessed that a 6-12 month supervised diet might be required. She said that they would let the physician's office know when they filed for approval. This doesn't make sense to me! Either they do, or they don't. Has anyone else run into this with this specific plan? Thanks! :confused2:

[Lisa65 3]

I have Anthem PPO in Ohio and I'm close to having the surgeon's office submit for approval. The insurance person at my surgeon's office said that Anthem is usually pretty good and they "don't require any crazy 6 month diet or anything." At least that's what she told me. Hope that helps you not to worry too much. I know plans vary greatly but her statement was pretty general. Good luck!

[ebowling 0]

I have Anthem BCBS from Indiana, and my policy requires an 18 month supervised program, then they will only pay $10K or my surgery if approved. While Anthem does approve this surgery, it still depends on your employers individual clause.

I decided to have the surgery and will be self pay. I am worth more than an 18 month medically supervised diet, that I will still have over $8K worth of medical expenses (with my deductible).

[kdlee 0]

Thanks for the replies. My insurance will pay 90% with $750 out of pocket. The surgery is covered by my policy but it seems like the reps I've talked to aren't very familiar with it. I have the info session with the surgeon a week from today, so we'll see what they say. The thought of needing to do yet another diet for 6 months is disappointing. I've been on a diet my entire life it seems, how is another 6 months going to make a difference when I'm still going to have the surgery???