APPROVED - Anthem Blue Cross Blue Shield

parrot0927 · October 24, 2007

I'm so sorry that they are doing that to you.

Desperate2lose · October 29, 2007

you may have saved my life. i tried to get this insurance before to no avail but i see this report is dated 2007 and i may actually have a chance. and now that my bmi is 40.6 (never thought that would be a good thing) i actually may qualify.

i can't express how much you may have just helped me by posting this. best of luck with yours and please keep us posted.

d2l

dustout · October 30, 2007

Yeah, prior to this new policy change a few months ago Lapband was almost always denied by Anthem BC/BS from what I here now they authorize it much much much more often! I was about 41 BMI when I went in. I drank a bunch of Water right before in case I like burned some ounces on the way from nervousness! lol.

I wish you the best of luck and I hope you can get it! It will definitely be great for you health. Keep us updated too!

I just started mushies. Scrambled eggs ROCK! I'm feeling so good and healthy. I'm so glad I did this so far!

Ellisa · November 2, 2007

Another week and still no response from Athem. They continue to be "too busy" to even enter my paperwork in their database. It will be 4 weeks on Monday since it was faxed to them. I just think that's totally rediculous for them to leave it in a pile untouched for 4 weeks. Any ideas? I can't get past customer service, who are very nice but as useless as utters on a bull (that's the polite version of one of my Dad's old sayings). They've left messages for "pre determination" but they are too busy to return calls. I only call once a week.

dustout · November 3, 2007

That sounds like the problem I had sadly. It's definitely ridiculous.... I think it took me around 4 or 5 weeks. Once they got the paperwork in the system it only took a couple of days though so hopefully they can get to you fast!

They left a note for the pre-determination people for me too around week four and a couple days later they returned the call and told me they started the process.

I would keep calling like you are. They document every time you call so maybe they will see that and think 'hey this person is anxious about this so she isnt just going to sit around and forget about it for a long time!'.

Ellisa · November 5, 2007

Thanks for the encouragement. I'll wait until Thursday and call again. I only call once a week, I don't think that's being too pesky.

Ellisa · November 7, 2007

Dustout,

I called Anthem yesterday and they said my claim was "in the sytem" and "pending." I should hear something by Friday. I'm not holding my breath, but I'm a little optimistic about it.

Ellisa · November 8, 2007

I finally got word from Anthem BC/BS... I was denied.

They gave a whole list of reasons. I'm floored. The insurance person at my Doc's office assured me that all of the i's were dotted and the t's crossed and she saw no reason it should be denied. Well I guess you live and learn. After spending the cost of the consultation plus $300 "program fee" the only thing getting lighter is my wallet.

dustout · November 8, 2007

What reasons did they give? Are you going to appeal? If you meet the reasons listed on the policy and your doctor thinks it's medically necessary you can write a letter of appeal disputing their reasons. They may just be trying to get rid of you to save them the huge cost of it.

Don't give up! At this point if you can I would certainly try to appeal this. They may just be hoping you give up. I look forward to hearing back from you. I'm so sad to hear they denied you though! I know I would be so disappointed in your place, even more after having spent money on this already.

parrot0927 · November 8, 2007

I agree with dustout. You need to appeal. If you meet the guideline and it's medically necessary, they should cover it. Don't give up! Appeal! Appeal! Appeal!

Ellisa · November 8, 2007

Yes I will appeal. But it's just so frustrating that they can jerk people around like this.

They read me a list of reasons, and all I could think was, "did they lose half of the paperwork that was faxed to them?" But I was too upset at the moment to deal with it.

When I get the letter (which was mailed today) I can give you the specifics.

Thanks for the support!

dustout · November 8, 2007

They "lost" my proof of student paperwork three times after they approved me for the surgery and kept trying to cancel my insurance without even notifying me this paperwork was missing. We kept having to fax them proof in. I think they can be a bit shady on this surgery. I think they really don't want to pay for it. It didn't actually stop the surgery but if we hadn't been on top of things it might have. The more I think about it the more shady it seems.

Good luck with your appeal and keep us updated!

Ellisa · November 10, 2007

The word I'm getting from my doc's office is that they think that there may be some missing paperwork. They were going to try to get to the bottom of it today, but I didn't hear anything.

Again, thanks for listening.