EllaMat13

Well I just found out Anthem CA doesnt require a pre-certification, but my Dr submitted one for approval today anyway. Do you think the Drs require it so they are sure they will be paid? I know with Medicare, for example, there are no pre certs, but you have sign a doc saying you'll pay any charges that aren't covered after surgery. Ugh! so nervous! how long ago was your surgery?

Hello all! Here is my ridiculous story involving the insurance end of things, and a few questions to follow. Back in August, I made my first call to start the journey toward surgery. I had UHC at the time and they covered the surgery and required every darn thing on earth, except the 6 month diet prior to surgery. My plan with them was ending 1/31/16 because my employer switched providers. My entire surgical team, along with every Dr I saw during the process knew that I had a deadline. And it seemed like I had plenty of time. Well, after many miscommunications, ball dropping, wrong fax numbers, etc my surgery was finally scheduled for January 27th. Talk about last minute! Well, to make it even more last minute, as I was being prepped for surgery at the hospital, everything came to a halt. Insurance still had not processed my claim. So they rescheduled me for 2 days later, and then 3 days later-they were willing to operate on a Saturday because they knew what a mess I was in. Long story short, UHC left the claim as "pending," most likely because they knew my plan was ending and they didn't want to pay for it. Thanks a lot United! Anyway, my new plan with Anthem Blue Cross California started today. And they require the six month diet. I've been dieting and working out ever since starting this journey, but it hasn't been documented because it didn't need to be. I've seen many posts online about submitting the claim anyway and it being approved without the diet, but all the posts seem to be quite a few years old. Has anyone had surgery through Anthem BC California recently? If so, what was your process like? Did they require the full six months documented diet? How long did approval take? Any information you can give me would be appreciated. I'm hoping my Dr can explain the situation directly to Anthem and get an approval. This has been the most stressful 5 months of my life!

I'm new here, so I hope this topic hasn't been covered already! I'm a very active person, I play roller derby and work out 5-6 days a week. I am especially into nutrition and Cross Fit. I came to my current weight via a variety of factors, but lack of exercise was not one of them. I would love to hear from anyone who is into Cross Fit and/or weight lifting and has been sleeved. I'm concerned about massive loss of muscle and having to start over on the lifting side of things. My nutritionist and trainers have been a huge help but I would love some support from those going through it!

Yes, I received a copy of my letter, but only because I asked for it. I just wanted it for my records in case anyone dropped the ball with insurance etc. It basically outlined my psych history and how the psychiatrist thinks I will fair in the long term, after surgery. Nothing terribly exciting!