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HELP BCBS ANTHEM FEP Denied Coverage for Lab Work

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Started by pronetus, Apr 29, 2007 9:54 AM
3 replies to this topic
3 replies to this topic

    pronetus

    Advanced Member

  • Posts: 46
  • Joined: Mar 2007
  • Surgery: LAP-BAND
Posted April 29, 2007 - 9:54 AM

#1
Hi Folks, I am in Northern VA and have BCBS FEP plan 105. I just received a statement from BCBS Anthem from some initial labwork with my primary care Dr. The Bill was $340 for EKG and lipid blood profile. the reason for non-coverage was that BCBS does not cover treatment for Obesity. Huh? I have a Barium swallow set up for net week. I am afraid I'd have to eat that cost.

Can anyone provide any help or guidance on this?

Thanks


    dotofoz

    Guru in Training

  • Posts: 272
  • Joined: Jun 2006
  • Location: OH
  • Surgery: LAP-BAND
Posted April 30, 2007 - 1:17 PM

#2

Hi Folks, I am in Northern VA and have BCBS FEP plan 105. I just received a statement from BCBS Anthem from some initial labwork with my primary care Dr. The Bill was $340 for EKG and lipid blood profile. the reason for non-coverage was that BCBS does not cover treatment for Obesity. Huh? I have a Barium swallow set up for net week. I am afraid I'd have to eat that cost.

Can anyone provide any help or guidance on this?

Thanks


Hi. I'd check your benefits brochure. If I'm not mistaken, it is a FEDERAL LAW that wls is covered in all federal employee health plans starting in 2007(check out Google--morbid obesity federal employee health plan). They can make you jump thru hoops, but it and all testing s/b covered! Also, check w/your Dr....I have bcbs federal ohio and had NO problems at all with anything! I'd definitely double check! Good luck! Oh, btw, enjoy the barium swallow! I almost puked not only on the tech, but the doctor!:)


    Candle

    Bariatric Evangelist

  • Posts: 965
  • Joined: Jan 2007
  • Location: NY
  • Surgery: LAP-BAND
Posted May 1, 2007 - 9:42 PM

#3
That's odd.

I also have Anthem BC/BS out of CT and so far they have covered all my pre-op testing. I have an exclusion on my plan ... sounds like you do as well. Did you check to see if you were covered for the band?

(I'm switching to a new insurance co before surgery)


    jnkntrnk

    Senior Member

  • Posts: 57
  • Joined: Mar 2007
  • Surgery: LAP-BAND
Posted May 9, 2007 - 8:46 PM

#4
I've just found out I've been approved for the surgery; by Anthem BCBS. But so far they are "pending" the EKG. I too have stuff setup for the rest of the clearances and am nervous. But I think I'll have the right to appeal any pre-op procedures once the connection is made between the two. The code on the EKG just said weight loss and didn't reference it as pre-op. Hopefully it will turn out okay.


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