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Anthem BC/BS in OH/Looking Good So Far



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I work for my local school system and have BC/BS. The system is "self-pay". I found out that WLS for morbid obesity is covered.

Yesterday I talked with 2 customer reps and the Finance Counselor for the weight loss surgery center I've chosen. I got the code for VSG surgery (43775). The ins. rep told me that VSG is mentioned along with all the other WLS (he named them all) and there was nothing that said VSG was investigational.

I'm going to the Surgery Center's seminar for potential surgical candidates on May 17th. This is required to get a consulation appt with the surgeon. HOOP # 1.

I am so determined to have this surgery and not to opt out for the lap band or RNY!! :tongue_smilie:

Waiting to LIVE! :thumbup:

Jeannie

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My seminar was today May 15, not the 17th. I was very impressed with the surgeon. He stayed and answered everyone's questions after the seminar. I felt comfortable with all his answers.

Guess what! He really prefers the sleeve to all the surgeries he offers! He told me so after the seminar.

They have a 3 month supervised diet, where they expect you to lose 5% of your body weight to show that you are serious and willing to change your eating habits.

He will not operate on anyone who is still smoking. They do a blood test to make sure you have no nicotine in your system.

The soonest I could get through all the hoops and have surgery is 4 months...which means Sept. of 2010.

I asked the insurance gal about my policy with BC/BS and she said as long as there is not an exclusion in the policy, she has been having no problem with them doing the sleeve!! I was OVERJOYED!:)

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    • BeanitoDiego

      Oh yeah, something I wanted to rant about, a billing dispute that cropped up 3 months ago.
      Surgery was in August of 2023. A bill shows up for over $7,000 in January. WTF? I asks myself. I know that I jumped through all of the insurance hoops and verified this and triple checked that, as did the surgeon's office. All was set, and I paid all of the known costs before surgery.
      A looong story short, is that an assistant surgeon that was in the process of accepting money from my insurance company touched me while I was under anesthesia. That is what the bill was for. But hey, guess what? Some federal legislation was enacted last year to help patients out when they cannot consent to being touched by someone out of their insurance network. These types of bills fall under something called, "surprise billing," and you don't have to put up with it.
      https://www.cms.gov/nosurprises
      I had to make a lot of phone calls to both the surgeon's office and the insurance company and explain my rights and what the maximum out of pocket costs were that I could be liable for. Also had to remind them that it isn't my place to be taking care of all of this and that I was going to escalate things if they could not play nice with one another.
      Quick ending is that I don't have to pay that $7,000+. Advocate, advocate, advocate for yourself no matter how long it takes and learn more about this law if you are ever hit with a surprise bill.
      · 0 replies
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    • BeanitoDiego

      Some days I feel like an infiltrator... I'm participating in society as a "thin" person. They have no idea that I haven't always been one of them! 🤣
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    • ChunkCat

      Thank you everyone for your well wishes! I totally forgot I wrote an update here... I'm one week post op today. I gained 15 lbs in water weight overnight because they had to give me tons of fluids to bring my BP up after surgery! I stayed one night in the hospital. Everything has been fine except I seem to have picked up a bug while I was there and I've been running a low grade fever, coughing, and a sore throat. So I've been hydrating well and sleeping a ton. So far the Covid tests are negative.
      I haven't been able to advance my diet past purees. Everything I eat other than tofu makes me choke and feels like trying to swallow rocks. They warned me it would get worse before it gets better, so lets hope this is all normal. I have my follow up on Monday so we'll see. Living on shakes and soup again is not fun. I had enough of them the first time!! LOL 
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    • BeanitoDiego

      Still purging all of the larger clothing. This morning, a shirt that I ADORED wearing ended up on top. Hard to let it go, but it was also hard to let go of those habits that also no longer serve my highest good. Onward and upward!
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    • Onedayatatime365

      Looking to connect with others who are also on the journey of better health. Post-Op Gastric Sleeve (4/11/24).
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