Seeking info about Anthem Blue Cross *** Insurance

[Megbd 3]

I've called my insurance regarding having the lap band surgery and what my coverage was and they told me I have no coverage for bariatric surgery unless they got a letter from the dr saying that it was medically necessary. I have yet to see a bariatric dr(I'm going to a seminar on Tuesday) yet and I'm a little scared/nervous that he won't see it medically necessary for me. I've been 100+ over for about 6 years now, my BMI is 45 but I have no diabetes, high blood pressure or sleep apnea or anything like that. (i would like to prevent that). I've tried dieting on my own and have been unsuccessful. Has anyone had any experience with having there Dr write up a letter? And what we're some of the things that he used to persuade the insurance to get the surgery if you didn't have any comorbidity?

[Thattanagirl 3]

I have blue cross anthem and it is covered. Once you go to the seminar they will get your insurance info and they will call anthem and get the "pre-requirements" you have to fulfill to get approved. I'm 5'3 and 287 and my BMI is in the 40's. I also have no other medical issues and the surgeon said I'm the perfect candidate. Not sure which plan you have but I have the 2k deductible and then 90% is covered after that. Just start with the seminar and they will get you on the right track. I'm getting the Lapband, I chose it bc I don't have any kids yet and with all the other surgeries you have alot malnutrition bc they cut most of your stomach out to bypass. Plus it has the least complications and its the least invasive and it can be altered with what they call "fills" so they can loosen and tighten it.

[Megbd 3]

I have the classic *** plan. Insurance said if it gets approved I only pay $250 (I assume that's my deductible) and the rest is covered by the insurance. But once I go to the seminar, the drs office contact my insurance about the surgery?

[Megbd 3]

I have the classic *** plan. Insurance said if approved i pay $250 (I assume that's my deductible) and the rest is covered my insurance, but It has to be medically necessary. But after lithe seminar, the drs office call my insurance?

[Thattanagirl 3]

Yes they will call and get all the pre requirements. I had to get a psych evaluation, an EKG, I had to go to 2 nutrition classes and 2 support groups and had to have a barium swallow, then I had to get my normal DR to write a recommendation letter.

[this sucks 557]

I had Anthem when I was banded almost three years ago. If the paperwork is complete, they will approve you with a BMI of 45 even without comorbidities.

I was approved at BMI of 40 with sleep apnea, hypertension and pre-diabetes with no problem.

Best of luck to you!!!

[Megbd 3]

So then my PCP has to write my letter of medical necessity. Not my bariatric surgeon?

[Chris_tina83 37]

I also have anthem blue cross. I spoke to my PCP about the lap band, and she told me I'd have to see her for months before I could get approved. I went to a seminar anyway and they checked my insurance and whatnot and told me it covered. I never went back to my PCP. I didn't need a letter or anything from her. My seminar was March 1st and I was banded April 26th. My BMI was 45, with no other issues, diabetes, high blood pressure etc..having a BMI 40 or more is really all it takes, in most cases and with insurances..

[PrettyThick1 1,860]

I've called my insurance regarding having the lap band surgery and what my coverage was and they told me I have no coverage for bariatric surgery unless they got a letter from the dr saying that it was medically necessary. I have yet to see a bariatric dr(I'm going to a seminar on Tuesday) yet and I'm a little scared/nervous that he won't see it medically necessary for me. I've been 100+ over for about 6 years now, my BMI is 45 but I have no diabetes, high blood pressure or sleep apnea or anything like that. (i would like to prevent that). I've tried dieting on my own and have been unsuccessful. Has anyone had any experience with having there Dr write up a letter? And what we're some of the things that he used to persuade the insurance to get the surgery if you didn't have any comorbidity?

Your BMI automatically qualifies you through BCBS and it's subsidiary companies, without any comorbidities.

[Megbd 3]

Thanks for all the informative feed back. I'm feeling really good about this. I had one other question. During the seminar, do they check your insurance and all that while I'm there and I'll know at the end of the seminar or how does that work? Do I wait to talk about the insurance part of it after I meet with the surgeon?

[Chris_tina83 37]

Thanks for all the informative feed back. I'm feeling really good about this. I had one other question. During the seminar' date=' do they check your insurance and all that while I'm there and I'll know at the end of the seminar or how does that work? Do I wait to talk about the insurance part of it after I meet with the surgeon?[/quote']

When I went to my seminar they did check my insurance. From that point on, I had my sleep apnea test scheduled, and it went on from there. I had an appt for the psyc eval and dietician, but that was done over the phone..had surgery in less than two months. But all insurances are different. Some make you wait 3 months, 6 or even a year. To monitor your weight. Good luck on your journey, best decision I ever made in my life! Keep us posted please!