Final Post:
To be clear: I have ANTHEM BLUE CROSS THROUGH COVERED CALIFORNIA IN CALIFORNIA!!
every anthem insurance is different. If you have it through a work plan you may have a waiting period, etc. Your requirements could be different. Also don;t confuse this with Blue Shield of California. They are not the same.
Here is how it went for me:
Step One: Called insurance to verify benefits and find out requirements.
40 BMI or 35 with any co-morbid condition
Choose a doctor in their provider list
Go to a CENTER OF MEDICAL EXCELLENCE blue distinction center
Step Two: Found a doctor and hospital combo after lengthy search.
I started with the hospital, by googling the blue centers of distinction list, and I found anthems list online. Then I called the hospital and got the list of surgeons who work out of it. Then I checked the surgeons in my Anthem directory to see who was covered. This took a long time and was frustrating. but I am glad that Anthem is requiring the excellent care that I am getting.
Step Three: I attended a seminar for the nutritionist and a NUT appointment and got weighed in.
I was weighed by my NUT at this time and my weight qualified me with a 40.3 bmi. I was then asked to lose 5% of my weight prior to surgery, which I did.
I was then given a list of my pre-op tests, which were- psych, ekg, blood work, gallbladder and liver ultrasound.
Step Four: Testing
I got right on the tests- this is huge. The pysch appointment took two weeks to come and two weeks for her to submit my report. Don't dawdle on the psych eval- get it scheduled asap because it can take a long time.
Step Five: Checked to make sure all my forms were received.
Once they were, my surgeons office scheduled me to meet with him and to get my surgery date.
Step Five: Met with surgeon and scheduled surgery for 4 weeks away.
I met with my surgeon, he thought I should do a sleeve but I refuse because of heartburn. He is amazing and handsome to boot! They re-weighed me at this time and I had lost weight putting me under 40 bmi, but they only submit the first weight as they had required me to lose weight prior to surgery.
They scheduled me for a surgery date, I was able to choose one sooner but my work schedule prevented it so I scheduled four weeks away.
Step Five: Submit to insurance
My surgeons office submitted my paperwork to the insurance within a couple of days.
Step Six: Insurance Approval
My insurance told me it would take 5 business days to approve my surgery. I called back after one day to check and make sure they had all the paperwork, and they had already approved my surgery and called the doctor to let them know!!
I was approved in 1.5 days!!
My bmi was 40.3
Weight 251 Height 5'6
Insurance: Anthem Individual plan through Covered California (Obamacare), Silver 94
I had NO 3 or 6 month diet requirement.
I had only to tell my surgeon's nutritionist which diets I had tried over my life.
So there you go!!!
If you have the same insurance as me, that's what to expect. Remember to make SURE your hospital is a center of excellence or your surgery won't be approved. Make sure you meet all the requirements and your golden!!
