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Anthem BCBS Insurance Approval / Denial Question

BigTexasMandy

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BigTexasMandy    60

BigTexasMandy
Posted

If there is a weight gain in one of your appointments during your 6-month diet plan, will you be denied even if overall you lose weight? For example, say I start at 300 lbs, lose 10 lbs in the first two months, gain 5 lbs during the third month, but then I lose 20 lbs over for a final weight loss of 280 lbs, will I be denied?

I have Anthem BCBS and I just wondered if they focus on the month to month or overall accomplishments. Gaining weight over the holidays seems to be a logical scenario, but I wondered about anyone else's experiences.

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QueenOfTheTamazons    634

QueenOfTheTamazons
Posted

I have Anthem Blue Cross Blue Shield and I didn't lose any weight during the six months. But they found other reasons to deny me. I had to fight with them for several months to get approval and we are still fighting with my with them for my husband's approval . do not take their denial to Heart or as fact. Fight it fight it fight

HW 385 SW 359 CW 326 (59lbs down!) Sleeved 10/5/16

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BigTexasMandy    60

BigTexasMandy
Posted

I have Anthem Blue Cross Blue Shield and I didn't lose any weight during the six months. But they found other reasons to deny me. I had to fight with them for several months to get approval and we are still fighting with my with them for my husband's approval . do not take their denial to Heart or as fact. Fight it fight it fight

HW 385 SW 359 CW 326 (59lbs down!) Sleeved 10/5/16

Gosh, I am so sorry that you had to go through all of that to get approved. Everything went so well with my mom when she did gastric bypass 5 years ago.

I'm so stressed about everything and depressed. I hope your husband is approved soon.

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emardee    192

emardee
Posted

I have Anthem as well. They denied me the first time, my doctor's office said not to worry about it and they filed a letter of appeal, was approved that second time.

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BigTexasMandy    60

BigTexasMandy
Posted

I have Anthem as well. They denied me the first time, my doctor's office said not to worry about it and they filed a letter of appeal, was approved that second time.

Sent from my iPad using the BariatricPal App

Well, I hope that turns out to be the case for me. I'm just so stressed and depressed worrying about everything. :-(

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Djmohr    6,965

Djmohr
Posted

@@Mandy Vachon

Try hard not to worry. I know that is easier said than done.

You don't have your stats listed so it is hard to know if you might have to jump through a few more hoops.

The reality is, you simply jump through each hurdle as it comes. This is not a short process to go through and there will be bumps along the way. The reality is, in the end every hoop and hurdle is worth jumping through!

In the meantime, focus more on changing behaviors and habits that will help you post surgery. This process is 90% head and 10% surgery. The surgery will be your tool but the behavior changes are what is needed to be successful long term.

You can do this! Just take one day at a time and keep your eye on the prize!

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BigTexasMandy    60

BigTexasMandy
Posted

@@Mandy Vachon

Try hard not to worry. I know that is easier said than done.

You don't have your stats listed so it is hard to know if you might have to jump through a few more hoops.

The reality is, you simply jump through each hurdle as it comes. This is not a short process to go through and there will be bumps along the way. The reality is, in the end every hoop and hurdle is worth jumping through!

In the meantime, focus more on changing behaviors and habits that will help you post surgery. This process is 90% head and 10% surgery. The surgery will be your tool but the behavior changes are what is needed to be successful long term.

You can do this! Just take one day at a time and keep your eye on the prize!

I've just been feeling depressed in general and I'm starting to really worry. I've got an appt on Monday and I'm going to talk to her about managing my depression. I know I'm capable of the necessary changes but I just can't pick myself up to move forward. It's not just tied to wanting this surgery, but of course, this is part of it. I wish I could see the light at the end of the tunnel. I know it will work out as it's meant to, but it's just really hard right now.

Thank you for your kind post and for taking the time to provide reassurance and kind words.

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Tashagirlxo    41

Tashagirlxo
Posted

If you don't mind me asking, why did they deny it the first time?

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emardee    192

emardee
Posted

My opinion is that they deny it out of habit. I never read the denial letter, because the doctor's folks told me they would deal with it and they did.

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AllyInDallas    22

AllyInDallas
Posted

I have bcbs anthem and am currently awaiting approval. I'm so stressed the surgery happens before the end of year because I have been saving my PTO and I can't roll it over. Not to mention I've already paid this years deductible. I actually had to gain a little weight during the 6 month diet visits to get to their minimum 40bmi to qualify. This waiting thing is so stressful.

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kmsull617    4

kmsull617
Posted

Do you mind telling which state your anthem bcbs is run out of? I am just starting the process and mine is out of NJ. Just wondering if I am going to have to deal with this too.

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Tashagirlxo    41

Tashagirlxo
Posted

@@emardee did you see your doctor for 6 months?

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@@emardee did you see your doctor for 6 months?

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Tashagirlxo    41

Tashagirlxo
Posted

@@kmsull617 , I'm in the same boat. I live in NJ and I'm trying to figure out which state my Anthem BCBS is from because there technically isn't a policy for Anthem BCBS NJ

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Go To Topic Listing Insurance & Financing

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    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 0 replies
      1. This update has no replies.
    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

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      Three months and four days ago... I was in Costa Rica having a life changing surgery! Yesterday we had a followup visit with Dr. Esmeral via video chat and this morning my middle number changed.  I'm down 47lbs and two pants sizes. I can wear a Large tshirt for the first time in like... 14 years! Woot!! Everything is going great. I have zero regrets. I went down to the riverwalk with a friend and walked 2 miles on Monday without even getting fatigued. And no more snoring or chugging pickle juice for crazy leg cramps! I need to go to the gym more... I'm making new shirts next week so that will motivate me. LOL But I'm also just not as TIRED all the time! I have a LONG way to go...but seeing the progress on the scales and in the mirror is a huge motivator!! Thank you all for cheering me on and supporting me!!
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