Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Recommended Posts

I guess I'll just wait and see. I've had sooooo many conflicting answers between insurance, coordinator and friends. If it happens, it happens




I know this reply is late but...I would download the Anthem App. I experienced lot of back and forth too. But once I got the app and put in my info in EVERYTHING was spelled out in black n white. It tracks how much has been applied to your deductible, max out-of-pocket, all the surgerys they cover at which hospitals etc. I had to do a 6 mo pre op weight checks btw. But I've heard of ppl getting credit for weight checks-supervised diets done previously.

Share this post


Link to post
Share on other sites

I went for my first appointment about a week ago. Had the majority of the testing required for insurance. When I met with the patient coordinator she told my my insurance required 4 months of nutrition and exercise counseling. I thought it was 6 months (I have Anthem BCBS). Does anyone else have Anthem? What have you been told?


I have BCBS IOWA I have to do 6 months supervised diet and can not have a gain.


Share this post


Link to post
Share on other sites

This is the Bariatric Surgery Policy for Anthem: https://www.anthem.com/medicalpolicies/policies/mp_pw_a053317.htm

My understanding is that different plans and states can have variations of this. For my plan (Anthem BCBC or California PPO) when I called Anthem to ask about the policy they directed me to look at that page. If you call your insurance and they don't give you a straight answer ask them if medical policy SURG.00024 is the policy that your plan uses or if there is a different one. Each plan should have a very clearly defined medical policy for coverage of any surgery included in that plan.

Share this post


Link to post
Share on other sites

I have Blue Cross Blue Shield as well. When I started this process in February I called Blue Cross Blue Shield to check on the requirements. They sent me a list of all of the criteria that I needed to have completed. I suggest calling Blue Cross Blue Shield and they will be able to give you the information and send you out a paper that gives you all of the criteria.



Share this post


Link to post
Share on other sites

I have to do 6 months. I have BCBS of Iowa


Share this post


Link to post
Share on other sites

I called BCBS, asked for requirements. They told me ask my hospital and WLS team. My team dropped the ball, failed to tell me I had to do 6 months supervised weight and education. I was supposed to have surgery in October. Now my date is Dec. 14th. Still waiting for insurance approval.


Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • Aunty Mamo

      Iʻm roughly 6 weeks post-op this morning and have begun to feel like a normal human, with a normal human body again. I started introducing solid foods and pill forms of medications/supplements a couple of weeks ago and it's really amazing to eat meals with my family again, despite the fact that my portions are so much smaller than theirs. 
      I live on the island of Oʻahu and spend a lot of time in the water- for exercise, for play,  and for spiritual & mental health. The day I had my month out appointment with my surgeon, I packed all my gear in my truck, anticipating his permission to get back in the ocean. The minute I walked out of that hospital I drove straight to the shore and got in that water. Hallelujah! My appointment was at 10 am. I didn't get home until after 5 pm. 
      I'm down 31 pounds since the day of surgery and 47 since my pre-op diet began, with that typical week long stall occurring at three weeks. I'm really starting to see some changes lately- some of my clothing is too big, some fits again. The most drastic changes I notice however are in my face. I've also noticed my endurance and flexibility increasing. I was really starting to be held up physically, and I'm so grateful that I'm seeing that turn around in such short order. 
      My general disposition lately is hopeful and motivated. The only thing that bugs me on a daily basis still is the way those supplements make my house smell. So stink! But I just bought a smell proof bag online that other people use to put their pot in. My house doesn't stink anymore. 
       
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      Oh yeah, something I wanted to rant about, a billing dispute that cropped up 3 months ago.
      Surgery was in August of 2023. A bill shows up for over $7,000 in January. WTF? I asks myself. I know that I jumped through all of the insurance hoops and verified this and triple checked that, as did the surgeon's office. All was set, and I paid all of the known costs before surgery.
      A looong story short, is that an assistant surgeon that was in the process of accepting money from my insurance company touched me while I was under anesthesia. That is what the bill was for. But hey, guess what? Some federal legislation was enacted last year to help patients out when they cannot consent to being touched by someone out of their insurance network. These types of bills fall under something called, "surprise billing," and you don't have to put up with it.
      https://www.cms.gov/nosurprises
      I had to make a lot of phone calls to both the surgeon's office and the insurance company and explain my rights and what the maximum out of pocket costs were that I could be liable for. Also had to remind them that it isn't my place to be taking care of all of this and that I was going to escalate things if they could not play nice with one another.
      Quick ending is that I don't have to pay that $7,000+. Advocate, advocate, advocate for yourself no matter how long it takes and learn more about this law if you are ever hit with a surprise bill.
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      Some days I feel like an infiltrator... I'm participating in society as a "thin" person. They have no idea that I haven't always been one of them! 🤣
      · 0 replies
      1. This update has no replies.
    • ChunkCat

      Thank you everyone for your well wishes! I totally forgot I wrote an update here... I'm one week post op today. I gained 15 lbs in water weight overnight because they had to give me tons of fluids to bring my BP up after surgery! I stayed one night in the hospital. Everything has been fine except I seem to have picked up a bug while I was there and I've been running a low grade fever, coughing, and a sore throat. So I've been hydrating well and sleeping a ton. So far the Covid tests are negative.
      I haven't been able to advance my diet past purees. Everything I eat other than tofu makes me choke and feels like trying to swallow rocks. They warned me it would get worse before it gets better, so lets hope this is all normal. I have my follow up on Monday so we'll see. Living on shakes and soup again is not fun. I had enough of them the first time!! LOL 
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      Still purging all of the larger clothing. This morning, a shirt that I ADORED wearing ended up on top. Hard to let it go, but it was also hard to let go of those habits that also no longer serve my highest good. Onward and upward!
      · 0 replies
      1. This update has no replies.
  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×