Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Help Anthem BC of CA



Recommended Posts

Hello everyone,

I am new to this site and have been looking through to find help with appeals. I have been denied 3 times by Anthem BC of California. I have a BMI of 59, high BP, diabetic and they keep saying telling me I don't meet their criteria.

Is there no hope as long as I am with them? I have not seen anyone talk about success with them just the horor stories. If you have had success or can give suggestiong about appeals I would greatly appreciate it because I am getting discouraged.

Thank you in advance

d

Share this post


Link to post
Share on other sites

Insurance is very complicated and frustrating. Why don't you call your insurance customer service number, give them your policy number and tell them you are contemplating WLS and want to know EXACTLY what their requirements are, such as miminum BMI, co-morbidities, any pre-op diet program or number of years of weight loss information and anything else you can think of. Don't tell them your name or than you've been denied. Then in a day or two, once you've reviewed everything that was ACTUALLY SENT IN TO THEM, call them back and ask what else they need in order to approve your claim on appeal. I don't know what else to suggest.

Share this post


Link to post
Share on other sites

I agree with Parrothead, you need to find "exactly" what your insurance company requirements are to qualify. In your denials, they should have told you why were denied. They are required by law to inform you. I find it hard to understand with your BMI and diabetes and blood pressure that you don't meet the requirements, but insurance companies will do anything they can sometimes to deny claims. is your Primary Care Physician supportive? Some insurance companies have a six-month plan which include group sessions, psyche eval, a certain percent weight loss. So you can't begin to move forward until you know what requirements are and why they denied. Have you appealed to your medical state board. You can always go over your insurance company and go to the state board, especially if they won't give you a reason for denial. Then last resort, hire an attorney that handles medical appeals.

Good luck

Trisha

Share this post


Link to post
Share on other sites

I have Anthem BC of CA, and had no problems with getting approved. They required a Psych eval, and a nutritionist assessment, but no supervised weight loss programs or anything like that. I called them and they sent me the information on Weight Loss Surgery. You need to call them and have them send you that. Also, they should of sent you reasons for rejection. You definitely have enough to qualify unless they have something very specific with the insurance plan that you have.

Share this post


Link to post
Share on other sites

My paperwork went to Anthem two weeks ago today (and counting!!!) I'll post when I get a decision. I have a BMI of 40 and no comorbid issues. Anthem e-mailed me the requirements and the clinic I am using verified I only needed a bmi of 40, phyc eval, nutrional assement and a letter from my primary. I just made the stated critera and had all three letters were sent in. We'll if they will approve.

Share this post


Link to post
Share on other sites

I have Anthem BC of AZ, my company home office is in CA and I was approved in 7 days with no 6 month diet... But my husband has been waiting since April 29th to hear if he is approved or not... our paper work was sent in within days of each other... You may want to find out if your employer specifically excludes weigh loss surgery. They can do that. With what you listed you would qualify.

Good Luck!

Share this post


Link to post
Share on other sites

I received my appoval letter from BC Anthem in the mail (SURPRISE!!!). The clinic is closed until Tuesday(Memorial weekend) I am assuming they have the same letter. The date on the letter was five days after my paperwork went in. In total I waited less than three weeks.

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • Alisa_S

      Gearing up for my consult 01/14! Starting to get a little nervous.
      · 0 replies
      1. This update has no replies.
    • Goyafigs

      I had VSG 11.20.24 with Miguel Burch, MD Cedars-Sinai and I am 1 month post-op. 
      · 0 replies
      1. This update has no replies.
    • DaisyChainOz

      🥳 Jan 1 2025 - Day 1 of Pre Op, surgery on the 16th! 😬😅
      · 0 replies
      1. This update has no replies.
    • Alisa_S

      Just been waiting until time for my consult with my bariatric surgeon. It's scheduled for Jan 9th. Turns out I won't actually be seeing him. Apparently it'll be with his P.A.             Not sure what to expect. I thought this is where the surgeon would discuss the best surgery option for me. For years I had my heart set on the sleeve, but I've read so many people have issues with reflux - even if they've never had it before - that they've had to be revised to the bypass. I already deal with GERD & take 40 mg of Omeprazole daily, so I started studying about bypass and honestly, it seems like it might be the better choice for me. How can we discuss surgery options if the surgeon is not there?
      What happened at your first consult? Trying to get an idea of what to expect, or maybe I should say, what NOT to expect.
      · 0 replies
      1. This update has no replies.
    • rinabobina

      I would like to know what questions you wish you had asked prior to your duodenal switch surgery?
      · 0 replies
      1. This update has no replies.
  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×