Hi everyone! This is my first post here but I have been lurking for a little while on the boards [emoji4] I currently am in my enrollment period for new health insurance with my new employer and have 3 to choose from - Anthem BCBS, UHC and Aetna. They have CDHP and PPO plans for all 3 and I'll most likely go with the PPO even though the premiums are a little higher, because the deductible on all would only be $500 with a $200 OOP max. All 3 plans are very well priced for me, not much difference between them, and all have do have Bariatric surgery covered (at least from what I can tell. They all just say it's a covered service but weight loss programs are not). Also, all my current doctors are in-network for all 3 and take all 3. (Except my PCP is a NP and is not in network with UHC there is a freeze on credentials with them)

Anyway! I am leaning towards Anthem and Aetna because of UHC not covering my PCP but want to know people's experiences with those insurances and getting accepted for surgery and having it covered. My BMI is 42 I believe and I am 25. TIA for any suggestions and help.

I vote Anthem. I work there and I have the insurance. I was just approved today with a 5 min phone call by my surgeon's office to the pre-such line. I think we have pretty fair reviewers, and a standard set of criteria.

Edited April 7, 20179 yr by Nursgirl

I vote Anthem. I work there and I have the insurance. I was just approved today with a 5 min phone call by my surgeon's office to the pre-such line. I think we have pretty fair reviewers, and a standard set of criteria.

Thanks! Luckily Anthem is the lowest cost option so that's a plus [emoji4] good luck, congrats on your approval.

Where do you work?
Those sound like pretty good plans.

Where do you work?
Those sound like pretty good plans.

I work at a bank - I should add it's a $2000 OOP max whoops

Ah, that makes more sense.
I couldn't believe an out of pocket max of $200
I was astounded.
$2000.00 sounds about right.
That is close to my OOP max.

Yeah which still is not bad considering my last employer my insurance was UHC with a 3500 individual deductible with 6500 OOP

Holy Cats
Insurance companies are so crooked.

Yeah that's when I worked for a company with less than 150 employees. Now I work for one of the 4 largest banks in the world...makes a huge difference. The smaller company just couldn't afford the kind of coverage I'm being offered now. They did however contribute 1500 to a HRA for each employee to help with that deductible

Cool.
I used to work for a huge company and I had awesome benefits.
But I was miserable, so I took a voluntary layoff.

I've recently gone to the very first informational class, and during it the facilitator said that members who have Aetna plans have a much more strict criteria during the 6 month pre-op phase. One being they cannot gain any weight, or they will be denied immediately. She had one patient gain one pound, and was denied the surgery (thankfully she was able to fight that and was able to get her surgery approved).
My vote is for anthem as well.

I've recently gone to the very first informational class, and during it the facilitator said that members who have Aetna plans have a much more strict criteria during the 6 month pre-op phase. One being they cannot gain any weight, or they will be denied immediately. She had one patient gain one pound, and was denied the surgery (thankfully she was able to fight that and was able to get her surgery approved).
My vote is for anthem as well.

Thanks for the info! I have been reading much more and I was starting to get the feeling Aetna is a little harder to deal with...

On 4/7/2017 at 2:41 PM, Nursgirl said:

I vote Anthem. I work there and I have the insurance. I was just approved today with a 5 min phone call by my surgeon's office to the pre-such line. I think we have pretty fair reviewers, and a standard set of criteria.

Hi there!

Quick question for you since you were approved through Anthem. When it came to approval, did they take your starting BMI or your current BMI at the time of the request? I don't have any comorbidities with 5 months left to go of my supervised diet..... so yeah. I want to lose as much as I can before the surgery to maximize the effectiveness. But, I also don't want to pay out of pocket! LOL.

Thanks in advance!

Tasha

1 hour ago, Natashca said:

Hi there!

Quick question for you since you were approved through Anthem. When it came to approval, did they take your starting BMI or your current BMI at the time of the request? I don't have any comorbidities with 5 months left to go of my supervised diet..... so yeah. I want to lose as much as I can before the surgery to maximize the effectiveness. But, I also don't want to pay out of pocket! LOL.

Thanks in advance!

Honestly, I am not sure. I think my starting was 71 and current is 67, So that was not worry for me. I can tell you the policy simply says BMI over 40, or 35 with comorbids. You may want to ask your surgeon which one they will submit.

1 minute ago, Nursgirl said:

1 hour ago, Natashca said:

Hi there!

Quick question for you since you were approved through Anthem. When it came to approval, did they take your starting BMI or your current BMI at the time of the request? I don't have any comorbidities with 5 months left to go of my supervised diet..... so yeah. I want to lose as much as I can before the surgery to maximize the effectiveness. But, I also don't want to pay out of pocket! LOL.

Thanks in advance!

Honestly, I am not sure. I think my starting was 71 and current is 67, So that was not worry for me. I can tell you the policy simply says BMI over 40, or 35 with comorbids. You may want to ask your surgeon which one they will submit.

I have my next Doctor's appointment next week. I better give them a call. Thanks!

I have my next Doctor's appointment next week. I better give them a call. Thanks!

If you can update with what they say! I am curious as well