I got approved about a month ago but I figured I would let people know in case anyone else wonders about things with this insurance.

I have Anthem Blue Cross Blue Shield PPO. It took about a month before I was approved. They claimed they were very behind for some reason so it took longer than normal. I only had to show some kind of proof that I attempted other weight loss methods and failed. In my case this included a life long history of up and down diets and I tried phentermine for a couple of months.

They are also going to cover the assisting surgeon and the Lovenox injections after. They approved me for same-day outpatient (unless of course there's a complication).

Hope this helps someone at some point! Surgery date is October 15, 2007!

Either way, Anthem itself has a main policy on Lapband which they created early this summer. Here is the link on what is required to be banded under anthem:

Redirect Page

This is NOT state-specific. It's extremely informative.

I've looked all over the Anthem BCBS site and this page is moved. I can't find it no matter where I look. Does anyone have it saved down somewhere or know where to find the moved file?

thanks -- B

They appear to have a NEW policy on the band effective January of 2008. It looks about the same as the previous one except it adds more information about what revisions of previous band/bypass surgeries are covered and what isn't... it's basically the same policy but expanded with many more details. Kind of harder to read now though....

Lapband Policy for anthem BC/BS as of January 2008:

SURG.00024 Surgery for Clinically Severe Obesity

Interestingly, I also found this policy on when they cover Panniculectomy and Abdominoplasty (removal of stomach sagging down from lots of excess skin)... This is good info to know for the future if you encounter problems with the stomach area:

SURG.00048 Panniculectomy and Abdominoplasty

Hope this helps!

Does this insurance also cover fills?

I have not used insurance for fills yet since I'm under the grace period still....

HOWEVER, my insurance tells me that, YES they DO cover fills if they covered the surgery. We called on two separate occasions to verify this. They gave me this Insurance Reference Number to give my doctor:

0207589397001

I would suggest calling and checking to make sure they will cover it for you but it looks like it's a YES. My doctor says they won't bill insurance for fills since they usually don't cover it but when I told them that my insurance said they cover it, they said they would be happy to file it for me. woot!

wow. thats totally great to know.

I have a link for the general info policy for BC/BS

SURG.00024 Surgery for Clinically Severe Obesity

That is the link to the revised new version effective January 1,2008.

They have also revised the plastic surgery and now you must require to have hanging skin past your private area in order for it to be considered medically necessary along with skin problems...etc... oh..and pictures..

hope it helps!

+Thank you so much for this information and the research you put into it. It is very helpful.

sharon;)

it is very hard to get plastic surgery covered for hanging skin from anthem bcbs. they used to cover it more easily than before; but they (at the many groups requests) are not covering it. you can't blame anthem. it is the group (employers, etc) who request what is covered and what it not. if you don't have the obesity rider, you usually don't get lap band or gastric covered regardless of your BMI, weight, health, etc.

Hi! I am currently waiting on approval for lap band with Anthem! Scared to death! I just wondered if anyone had any problems getting approved with Anthem and if they appealed it and got approved. And...has anyone experienced weakness after surgery due to eating less? Thanks so much!

If you've read the rest of the post, you pretty much know my approval story.

As for weakness, I can tell you that it's been quite the opposite. Energy has done nothing but increase. Eating enough Protein and reducing "bad" carbs (sugar, starch) has helped to keep my blood sugar from dropping and making me tired. Also, eating small frequent small meals keeps you from feeling extremely hungry. I should be eating 5 -6 small meals, but I let my hunger dictate when I eat so it's usually 4 - 5 meals. Of course there are times when I might be feeling hungery in 2 or three hours after eating, but it's just not convenient to eat right then. But the hunger isn't overwhelming and I don't feel sick or shakey.

For those with BCBS, I am in Nevada. My refferral packet was sent to BCBS on 1/24 and I received my approval 1/31. I was 35.4 BMI so I was really sweating it. Now my surgery is scheduled for March 5th and I am one lucky girl!!. Make sure yoru case manager has their **Schtuff** together. Best wishes. girlie

I was sweating getting the bill I got the bills from the hospital a total of about 42k I was about to die when i seen it. I got the bills after the insurance pd I about died again (if that is possible) the way it looks now I will only have to pay approx 600$ out of pocket after the ppo deductions ect. I could cry I figured about 1600. I am very pleased with anthem bsbc. Hope everyone else does as good if not better.

FYI Currently awaiting insurance approval from Anthem Blue Cross PPO for the lap band by dr a koura

Just putting in my 2 cents from my personal experience:

I was just approved for surgery with Anthem BCBS (Husband works for Fedex/Kinko's). Apparently they used to have a BMI restriction (wouldn't do the surgery if the BMI was over 49) but it was removed at the end of 2007.

I do not know if this was a restriction placed by BCBS or Fedex/Kinkos.

My paperwork was submitted right after the holidays so it took them about 2-3 weeks to get back to us. My husband ended up calling pretty much every day to keep track of the progress.

I had my appointment Friday and they assured me they'd rush my stuff through as I'm concerned about actually losing my insurance. I'm really hopeful this goes well, from start to finish.