Anthem BCBS high deductible plan

[Leesa926 72]

My plan is a high deductible plan. My deductible is $3000 and once that is met everything is covered.

I called to ask if WLS is covered and they said yes all I need is preauthorization. I said from the surgen and they said yes. That is all they told me. My initial appointment is Wednesday.

Reading about all of these requirements has me nervous as they told me no requirement. I guess I am just anxious.

I am over 40 BMI but don't think I have documented weight loss if needed. I have done weight watchers on and off for years and my regular doctor prescribed me weight loss medicine twice not sure if that would count.

Looking for any informaion - thanks!

[Daisee68 2,493]

Mine (Cigna) told me I was covered but didn't tell me all the requirements. Surgeon's office did. Pretty sure you will since you have BCBS. If/when they tell you what the requirements are, don't get frustrated or detoured. All of my pre-op wait paid off in the end. I would never have truly been ready if I hadn't had that 4 months to prepare.

[Scarlett72 13]

I also have a high deductible. $6,000 which has almost been met. My surgery is next month.

[Leesa926 72]

Congrats. My family deductible is $6k

[Sharon1964 2,530]

I called to ask if WLS is covered and they said yes all I need is preauthorization. I said from the surgen and they said yes. That is all they told me.

This doesn't mean what I think you think it means. (say that three times fast!)

It doesn't mean your surgeon has to approve you. It means your surgeon has to send in a pre-auth request with the documentation of medical necessity for the surgeon, and then your insurance company evaluates the request and approves or denies.

[Leesa926 72]

Figured as much. I guess I will find out what's needed when I go Wednesday. I'm still at the is it right for me stage....

[mlilwood 13]

I have anthem too. My plan covers it with six months weight loss plan. I'm using the time my doc gave me the weight loss meds. Office said that would be okay. Hope it works for you too.

[Daisee68 2,493]

@@mlilwood - I have Cigna not BCBS but my program specifically stated:

"Programs such as Weight Watchers® , Jenny Craig® and Optifast® are acceptable alternatives if done in conjunction with the supervision of a physician or registered dietician and detailed documentation of participation is available for review. However, physician-supervised programs consisting exclusively of pharmacological management are not sufficient to meet this requirement."

Not saying necessarily that BCBS requires same, but your post caught my attention and I would hate for you to go through everything and then get denied. You might ask BCBS for a copy of their specific medical coverage details - or ask that question specifically to BCBS not just the surgeon's office.

Not trying to be bossy - just thought I would throw in my 2 cents!

[mlilwood 13]

Thanks.

[Leesa926 72]

I agree. From what I read prescription such as phentermine wouldn't count. I have weight watcher history nut hear that is IF the doc will sign off on it.

I have been on and off weight watchers and pills for years so I would hate to have to document 6 more months.

I go tomorrow will keep you posted.

[Leesa926 72]

Well I went today and it seems my insurance wants the 6 months supervised. I am not opposed to waiting specifically if the doctor says but seems they want people to back out. I have done so many things at times with doctor but not consecutively. I have been on weight watchers many times even now but not sure that can count.

Doctors office said I should talk to my primary and see if he would write a letter. I made an appointment in 3 weeks (he is on vacation)

My worry is 6 months puts my last weigh in at mid Dec. I won't be able to have surgery until January and then I loose out on everything I paid into my deductible.

Any one have success getting the 6 months waived or reduced?

[jss1988 54]

Hey Leesa926,

I read your post and it caught my attention. I had my first consultation in June and had the wind knocked out of my chest when they told me Anthem BCBS requires 6 months of weight loss counseling. I honestly believe that this is a tactic to get people to back out so that they do not have to pay out for the surgery. Why else would you tell a morbidly obese person to wait 6 months before they could lose the weight that is killing them slowly? My BMI is only 43 which means I cannot lose more than 30 lbs or I will be disqualified. I tried to get my 6 months waived because I have been doing a weight loss coaching program through Anthem since October 2014 and they said that it did not count because it was not doctor-supervised. Sounds like we are both in the same boat and will have surgery around the same time... Best of luck!

[BeginAgainDay 6]

I have BCBS. Besides all the pre-screening appts - abdominal ultrasound, sleep study, upper GI, EKG, chest xray, psychological evaluation, pulmonary, nurtitionist, I also had to have 4 years of weight, and weight loss programs documented and sent in by my PCP. I also had to write a letter stating why I wanted the surgery. I started this process in February. The paperwork was submitted to BCBS today 7/10th. My surgeon schedules 6 weeks out based on approval date.

Edited July 11, 2015 by BeginAgainDay

[Jersrose43 837]

I waited and started my first visit in December 2013. Then started the program. Mine was 3 months. I was ready in June.

I think you underestimate the program. It's part of the journey not a reason to back out. I learned a lot from meeting with a nutritionist and reading and analyzing everything I could. Including coming on these boards.

It's time to ensure that you are truly ready for a lifestyle change. I've read a lot of posts where folks just went right into it without a wait period and truly felt they weren't ready.

Use this time to your advantage.

I had a $4500 deductible and $9k out of pocket. I was not willing to pay and put my finance at risk of a December snowstorm or holiday. I waited.