Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Recommended Posts

* Anthem Blue Cross of California, Covered California Plan through the individual marketplace. Silver 95 plan.

remember, if you have anthem through your work your requirements may be different.

Share your experience with this insurance and let's help out each other! There is nothing so stressful as the beginning. I was so confused by this insurance process I am doing this to help other's in my situation. Let's help out!

1 what was your doctor and hospital

3 what medical requirements were there?

4 what medical tests were required?

5. Did you have to do a supervised diet?

6 how long for approval?

7 what was good about them?

8 what was bad?

9 what should we know to watch out for if anything.

Edited by bellabloom

Share this post


Link to post
Share on other sites

I have Anthem BCBS , no supervised diet. Had my first consultation with the nurse,surgeon, and dietician on 9/18/14, followed by blood work with the lab. On 9/24 I met with the psychiatrist (required) . I had another appt with my nurse,surgeon and dietician again on 10/2 and scheduled my surgery for 11/18! I am just waiting for the approval from the insurance. So far smooth sailing and the representatives at bcbs have been great! Fingers crossed!

Share this post


Link to post
Share on other sites

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!!

Share this post


Link to post
Share on other sites

I have the same plan . How much did your out of pocket expense end up being?

Share this post


Link to post
Share on other sites

$1800. Could have been up to $2500 but I had used some of the yearly max already. :)

Share this post


Link to post
Share on other sites

My insurance covered my 50000 hospital bill except for 1800 of it. :)))) if you have any questions or need help at all please don't hesitate to ask.

Edited by bellabloom

Share this post


Link to post
Share on other sites

Thank you! That's awesome congratulations! !! How are you doing so far?

Share this post


Link to post
Share on other sites

My insurance covered my 50000 hospital bill except for 1800 of it. :)))) if you have any questions or need help at all please don't hesitate to ask.

I have Anthem BCBS , no supervised diet. Had my first consultation with the nurse,surgeon, and dietician on 9/18/14, followed by blood work with the lab. On 9/24 I met with the psychiatrist (required) . I had another appt with my nurse,surgeon and dietician again on 10/2 and scheduled my surgery for 11/18! I am just waiting for the approval from the insurance. So far smooth sailing and the representatives at bcbs have been great! Fingers crossed!

How did everything go?

Share this post


Link to post
Share on other sites

I'm doing awesome thanks for asking! 6 weeks out and 35 pounds down. It's not easy all the time but I'm so glad I did it and anthem was amazing!!

Share this post


Link to post
Share on other sites

Would you please assist me? I have Anthem Blue Cross Covered CA Bronze 60.

I have two hospitals in my area (within 10 miles) with both blue center of distinctions however the one Dr I called - receptionist said they won't accept ABC Covered CA.

When you called the hospital did you ask for Bariatric surgeons only?

I have the list of surgeons on the ABC Covered CA website but out of 250 for my area not one Bariatric surgeon is listed nor is not listed under the drop down.

What type of surgeon did you use and are they listed under something else?

What area do you live in?

I wonder if I am going to have to travel outside of 25 miles even tho I have two hospitals right here if I want this done.

Share this post


Link to post
Share on other sites

My daughter has Anthem Blue Cross through her employer here in California. She is looking for a bariatric, obesity supportive primary care physician in the LA/Glendale/Pasadena area so that she can start the journey towards weight loss surgery.

Can anyone give me names of some LA area primary care physicians that support a bariatric surgery option as a way to lose weight?

Thanks.

Share this post


Link to post
Share on other sites

Does anybody know which anthem blue cross plan would be right for me since anthem is not clear which one has WLS and covers people with a lot of health problems? I really want anthem but I need to know which plans are good for this. I don't have much money, I currently get medi-cal which sucks in this county (I live in Solano county). I also gave up on getting WLS with mediaid/medical because they just suck and take too long. I figure I should just start with Sutter again so I don't have to start everything over again since I ride with them before. Please note this will be now my 3rd time trying for WLS and I need a plan that lasts only a year and a half and will just have to use Medicaid after that for anything else since once again my trust does not have much money.

Share this post


Link to post
Share on other sites

I'm thinking about getting Anthem Blue Cross of California's Platinum 90 D PPO plan. How is that plan for bariatric surgery? Because I want to know what I'm paying for before I buy it.

Share this post


Link to post
Share on other sites

Thanks for the information. I'm also doing Covered California/MediCal, and it appears they will cover the whole thing, as I have no income, but plenty of medical issues that are aggravated by my morbid obesity.

My highest weight was 299 pounds, and I'm currently at 283. The first time my surgeon saw me, I was at 294 pounds.

Waiting on two years to pass since I was first insured so that the insurance will approve the surgery. Two years will be April 2016.

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Recent Topics

  • Most popular:

  • Recent Status Updates

    • GainingChelsea

      Currently waiting on a surgery date. Hope to hear soon. I have been fighting for the sleeve surgery for 10 years. I am so ready!
      · 0 replies
      1. This update has no replies.
    • Krestel

      How can a bowel movement make me lose almost 4 pounds? How much poo am I full of?
      · 3 replies
      1. lvidacovich

        I haven't pooped in a weed and I'd love a 4 pound poo right now lol

      2. ms.sss

        Lol, yeah, I've been known to drop 3-ish lbs after a good (and long awaited) poop.

        .....or even after a moderate to severe dumping episode. yikes.

      3. FluffyChix

        Those are championship cups for both you guys! :) I personally came up a 1.4lb winner this morning. ;) hehehehe.

    • *Meaghan*

      I met with my surgeon on Friday.. I've completed all my tests and all my nutrition meetings as well as meeting the weight loss requirements for my insurance. We are officially submitting to insurance for approval and I was given a surgery date of January 16th 2020 (13 days before my birthday!) Fingers crossed all goes through 
      · 0 replies
      1. This update has no replies.
    • Krestel

      Ok, now im getting old...my body gets me up at my normal 5am dog walk even when it's the weekend, vacation, and most importantly when I'm sick. So now that I have more energy, my body wants to make sure I suffer even longer during the day when I have a cold! Damn being healthy again! (:D)
      · 0 replies
      1. This update has no replies.
    • GreenTealael

      At my Primary Physician appt, the Doc said you know you lost a whole person. When you started seeing me you were 265lbs now you're 148lbs.
      She's right... I lost the fun me 😂 Joking Joking Joking. It's amazing who keeps track when you don't like insurance and browsers feeds
      · 2 replies
      1. Orchids&Dragons

        I think you're fun! You must have been a firecracker before!

      2. GreenTealael

        I don't even drink anymore 😂

  • Trending Topics

  • Together, we have lost...
      lbs
    ×