Anthem BlueCross

[burneyatchley101213 7]

Hi!

My name is Brittany and my husband Michael and I are doing the sleeve surgery together. We live up here in California, right along the border of Cali and Oregon. We've been going to Southern Oregon Bariatric center since we decided to do this surgery last November. Our first appointment was 3 days before Christmas on December 22nd and that got everything put into motion. Our insurance is going to pay 90/10. Today we went in for my husband to meet the surgeon as his surgery was looking like it was going to be early next month. BOY WERE WE WRONG. Upon preauthorized approval, we were told that Anthem no longer works with that specific center in Oregon and we can only be authorized to have our surgeries in California. Now this wouldn't have been a problem for us if they had told us at the beginning and we weren't already 95% of the way done with our insurance requirements. The big problem is travel for us now. We were approved to go to UCSF in San Francisco but that's almost 6 hours south of us (we're in the middle of nowhere, I told you). Has anyone had this problem? This was a huge setback to us, now we have to take the time off of work to travel down there and make sure our appointments can be all at once.

Has anyone even had this problem with Blue Cross not accepting an accredited facility?

[October262007 1]

Im also in Cali but on the central coast. I'm currently driving 3.5hrs south to ventura/la area for my surgery... there is nothing else local. Im about 3hrs from Fresno, 3hrs from SF etc... it has benn a huge pain, and I can totally relate

[HappyValleyHappy 48]

Good morning. I'm in Redding. There is a center of excellence in Chico and there is another in Pleasanton. Those are fairly handy for you.

[angelzadee 0]

I have BCBS Anthem as well and I'm in TN I thought the process was going to go pretty smooth but I found out when I did my consultation that I have to have 6 months of consistent weight loss management by a doctor within the last 24 months. So now I'm having to wait 6 months or more before qualifying.

[October262007 1]

I have Anthem through Sisc. I printed out 6 months of my Sparkpeople.com account with weekly info on weigh ins, exercise, Diet, Water and nutrient intake. There were a lot of pages, but my surgeon sent it in eith a letter that he had reviewed it and found it sufficient. I was approved 3 days later (May 4th) and got my surgery date that same day. I got sleeved on May 18th.

[Hopscotch 57]

I have Anthem BCBS Delaware, I got my surgery down where I live in Virginia, but I made sure to call them for authorized facilities before starting my process. I had to do 6 months of nutritional training before I was approved. I was approved in 1 day after my training and psych visit were submitted to them.

[hockeyfan7 249]

I have Anthem BCBS and when I had my first surgery they told me I didn't choose a Bariatric Center of Excellence. I explained to them that I went to the center THEY TOLD ME TO GO TO. They checked their records and admitted they made a mistake and I was good to go. I would appeal.

[CaPoppy 22]

I had mine done in Chico and I highly recommend them! I had Dr. Simchuk and he is fantastic. Enloe (the hospital in Chico) has a whole wing for Bariatric patients. Simchuk and Ludwig also have the nicest staff, and the Dr.'s are available to you 24/7 for ever. At my orientation it was mentioned that Dr. Simchuk did a house call for a patient on Thanksgiving Day!

Let me know if you have any questions!

[Jersrose43 837]

Sounds like anthem wants you at a center of excellence. So as having worked years ago for the blues here is se advoce. Hope it works.

Call your local bcbs plan- is that regence??

What are their centers of excellence in that state for that bcbs plan

Contact anthem advise them of the COE in that area.

Advise anthem that you wish to use your BLUE CARD - AWAY FROM HE CARE program.

Do you have a little briefcase on your card? That's a hint that you are covered worldwide for services through a local bcbs partner.

Anthem needs to play nice and honor their bcbs association licensure agreement.

[justaboutme 42]

I have Anthem in KY and when I called for the info packet they didn't specify if I had to do a weight loss program before hand. When would I find that out?

[Jersrose43 837]

I have Anthem in KY and when I called for the info packet they didn't specify if I had to do a weight loss program before hand. When would I find that out?

You can call them and ask for a copy of the medical policy which can details the specific items you need

The medical "packet" comes from the surgeon who will usually require more than an insurance company requires

[justaboutme 42]

Thanks! I'm just so anxious to see what hoops I will have to jump through to get this party started.

[hockeyfan7 249]

Thanks! I'm just so anxious to see what hoops I will have to jump through to get this party started.

I have Anthem BCBS. When I had my surgery I had to use a Center of Excellence. I was supposed to do the 6 month program but my PCP wrote a letter stating that I had been paying for Weight Watchers for a year and had been following Atkins with her before that. They accepted her letter.

I had to have a bone density test, sleep study, mammogram, pregnancy test, H-pylori test, 2 meetings with a psychiatrist, 2 meetings with the nutritionist, EKG, chest x-ray, bloodwork and pay my maximum out of pocket up front before I was approved.

[jess9395 5,450]

Im also in Cali but on the central coast. I'm currently driving 3.5hrs south to ventura/la area for my surgery... there is nothing else local. Im about 3hrs from Fresno, 3hrs from SF etc... it has benn a huge pain, and I can totally relate

Where are you on the central coast? My doctor was wonderful and he's in Santa Maria.

[justaboutme 42]

Thanks hockeyfan for the info. Patiencee is not my best virtue but will have to wait and see what insurance tells my doc. The hospital is a Center of Excellence and will see what tests I will have to have. I'm post menopausal so pregnancy test is out! LOL