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Anthem BCBS Insurance Approval / Denial Question

BigTexasMandy

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emardee    192

emardee
Posted

Tash, I saw my doctor for about eight months, worked through the tests, approvals, counseling, etc. Then surgery had to be postponed (two days before I was scheduled) because they found out I was severely anemic. I was on Iron for six more months, then they found out I had bleeding ulcers, had to take medication to heal those, yada yada. From my first appointment to date of surgery I'd say it was about 18 months.

@@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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kmsull617    4

kmsull617
Posted

@@Tashagirlxo , when do you anticipate your procedure? I already completed step one with psychologist and he sent me to 'immersion day' pre op one day session - I said do you think I'll have my procedure by March and he said 'oh I think before that' so I have February in my head. Hopefully I'm not setting myself up for disappointment.

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BigTexasMandy    60

BigTexasMandy
Posted

I live in Texas but my employer is based out of Georgia. I am not sure if where I live makes a difference. Technically, I'm considered corporate but we have "local" or "regional" employees who's insurance coverage can vary. For example, employees in California can get (or have to get - not sure) Kaiser Permanente insurance.

I personally am in my six-month diet phase just worried about the potential for rejection. I am not sure why I thought it would be a good idea to schedule my next appointment the Monday after a food holiday. The following appointment will be the Tuesday after Christmas.

It's amazing how much weight can fluctuate. I'm also battling bad depression so I'm hoping she takes mercy on me and that Anthem BCBS does as well. Hopefully, as long as I lose enough to show a net loss it will be okay.

This month has certainly scared me so I will be making better choices and hopefully not stress. I hope to do what @@Djmohr suggests which is take it one obstacle at a time. In the end, it will work out the way it is meant to...

I just wish it were easier to seek approval and that there was more support. In the end, isn't it more affordable for insurance if I weigh less and don't end up with weight-related health issues?

:( :( :( :( :( :( :( :( :(

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BigTexasMandy    60

BigTexasMandy
Posted

I wish I lived in Dallas. My husband's company (although we are in Austin) allows BCBS of Texas if we live in Dallas but not Austin. He has to go with Aetna. Sigh. Stupid insurance.

I live in Alabama but have bcbs of Tx. With my particular plan i don't have a 6 month waiting period. As long as I meet bmi and all pre apts I'm good


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Tashagirlxo    41

Tashagirlxo
Posted

@@kmsull617 should everything go well it should be in January. I'm just hoping they don't require the 6 month supervised diet. I'm preparing for the worst just in case. I started this whole process the beginning of October. It appears that the 6 month supervised all depends on the state. I would just prepare for the worst which would be another couple months of waiting. We shall see

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wdwfan20    0

wdwfan20
Posted

@@Mandy Vachon I gained 2 lbs in between my 1st and 2nd appointments. I was down only a net of 3 lb at my 3rd and final appointment. I was still approved the first time. I think they really look at everyone individually for approval. I have had good experiences so far with them. Rely on your dietitian and doctor's advice here.

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kschultz007    6

kschultz007
Posted

@@kmsull617 should everything go well it should be in January. I'm just hoping they don't require the 6 month supervised diet. I'm preparing for the worst just in case. I started this whole process the beginning of October. It appears that the 6 month supervised all depends on the state. I would just prepare for the worst which would be another couple months of waiting. We shall see

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Just depends on your plan. Not state

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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.

    • CaseyP1011

      CaseyP1011

      Officially here for a long time, not just a good time💪
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    • KimBaxleyWilson

      KimBaxleyWilson

      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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      1. This update has no replies.
    • bellaamey

      bellaamey

      https://alluniqueguide.com/java-burn-coffee-reviews/
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