Good evening everyone. I recently had my bypass and now my best friend is trying to get approval. She received a letter in the mail today from Anthem BCBS stating she was denied stating she didn't meet the criteria. She has 12 months Doctor supervised weight loss psych eval and nutritionist approval.

I would love any tips to help get her approved.

Here is a link to Anthem Blue Cross California medical policy for bariatric surgery. https://www.anthem.com/medicalpolicies/policies/mp_pw_a053317.htm

BMI of 35.5 is right at the borderline of being covered at all.

Blue Shield (CA HMO) does consider obstructive sleep apnea a qualifying comorbidity. Hope this helps!

Edited October 15, 201510 yr by 2goldengirl

I have Anthem Blue Cross. My BMI was just under 34. I had sleep apnea and bad knees so that I "needed" to take painkillers. I had a hernia too. No wait period. I was approved with no problems.

Edited October 17, 201510 yr by Linaka

Hi all,

I was denied even after the peer to peer review. My surgeon said my sleep apnea is too mild & I don't weigh enough but he will do it self pay. So I'm digging into my savings & paying it as a cash pay. I am super sad about it but I need to move on. I am hoping with my new found energy & spirit I will make that money up over time. It's lime my surgeon said people spend more money on a car than this surgery. I thought about going to Mexico but my husband & family won't support that. Thanks to everyone for your kind words.