Coverage with Anthem Blue Cross B/S

[Morgandobes 0]

Hi all

Just posting for those who have Anthem Blue Cross Blue Shield.

For MY employer(I hear employeers can have different coverages),

They will cover the sleeve with pre-certification and medical necessity needs to be shown.

They then cover 80% with a 1,000 deductible, then up to 2,000 out of

pocket then they pick up the rest.

Just in case anyone else has this insurance company.

Lisa

[Morgandobes 0]

This has turned out to be not true.

I was told by the customer service rep that it was approved, but when my case nurse looked at it, she said it was still considered investigational.

Looking at the appeals process

[KabinKitty 10]

I have Anthem BC/BS (Blue Access) in Ohio. My surgeon consult is June 17th. I've spoken with the insurance rep in my surgeon's office. She is having no problem with BC/BS (she says) covering the sleeve.

I have no deductables for surgery with my policy. If you're at an in-network hospital and using an in-network doctor. Both the hospital and doctor are in my network....so I'm hoping to not any to pay anything.

I know I could have GBP approved with no problem, but that's not what I want. The surgeon and his employees are know to be GREAT with appeals and getting ins companies to approve surgeries. They are a "Center of Excellence" facility...one of two in Ohio. :thumbup1:

[Morgandobes 0]

Thanks Jeannie

Its good to have that information. I talked to Federal originally, and they told me that they cover it, but when my case nurse looked at it, she said it likely wouldent be approved unless I had a very high bmi and it was part of a two part procedure.

So, my docs office let it go at that, and I got approval for the RNY. But, like you, thats not what I want. So, on Wednesday, I had my docs office submit the paperwork for the sleeve. I havent technically gotten a denial yet, just what the case nurse said.

Maybe with a little luck, I will get it approved.

Thanks, and good luck to all of us!

Lisa

[KabinKitty 10]

Lisa,

It's comforting to know that someone else is going through the same thing. I'm so ready to lose this "fat suit". It would be a blessing just to start a pre-op diet! I'm afraid to lose an ounce as I'm under 40 BMI, but I do have the co-morbidities.

I live on this computer, trying to learn all that I can before my surgical consult. He also does a physical at that time. Any idea what that involves?

I don't have a clue.

The best to you! I hope you get some good news real soon!! :001_tt2:

[KMP85 11]

YEAH!!! THANK YOU! If they werent covering my sleeve I was doing my lapband

Hi all

Just posting for those who have Anthem Blue Cross Blue Shield.

For MY employer(I hear employeers can have different coverages),

They will cover the sleeve with pre-certification and medical necessity needs to be shown.

They then cover 80% with a 1,000 deductible, then up to 2,000 out of

pocket then they pick up the rest.

Just in case anyone else has this insurance company.

Lisa