Insurance requirements for Anthem BCBS

[Ready2sleeve17 3]

Hello all! I'm new to this forum and just started my journey. I had my consultation spot on 7-5, my Upper Gindine today as well as my psych evaluation and first nutrition appointment ( I have to have 6 consecutive months). I'm very nervous because I want to get it don this year because I've met my deductible and out of pocket maximum so my surgery will be 100% covered! I'm scared because my last nutrition appointment will be 12/13 which is cutting it close!!! Anyone experienced these? Can you give me words of encouragement??? Thank you in advance!!!!

[Newme17 3,444]

100% is awesome. The only thought that came to my mind is given the fact that it's cutting close to the end of the year, is to stay on top of your surgeon's office/team. Keep yourself in the loop, always ask questions. Ask them how they manage patient records (are they staying on top of them daily, etc). I did. My team sent them off and not even 24 hours later, I was approved. Also, call your insurance company and ask what their policy is for the approval process. Maybe they'll make note in the system and see that you're serious??? I called mine and did this as well. Make sure you make all appts, don't reschedule any (they have to be consecutive--as with most insurances). Blessings on your journey hon!!! It'll be here before you know it.

[KateBruin 344]

If you just started and you need it by dec 31 you might not make it. I think I'm like $800 short of my max out of pocket and medi-cal should take care of the rest.

Make sure you ask your scheduler to make a tentative surgery appt before the end of the year. Mine make a 7/31 appt like 2 months in advance because I was already meeting all but 1 requirement.

[heycrystal2052 430]

You should still be okay, my approval was done in less than 24 hours and my surgery was scheduled two weeks after. Keep in mind, when we review PA's (I'm w/ BCBS) towards the end of the year, our TAT (turn around time) is a bit longer than usual. Ask the MD to send it in as a STAT, due to the end of the ear urgency. Depending on your review team, if it is not life threatening, it may be downgraded to a standard. Make sure your medical team submits everything, so it does not pend for additional information, that can extend the time significantly.

Crossing my fingers for you, congrats!

[Ready2sleeve17 3]

Thank you Crystal I appreciate your comment. I'll make sure they stay on top of it .....even if I have to have surgery on New Year's Eve!

[smb123 51]

I too have Anthem and have meet my deductible this year. I haven't started the six month thing yet. I am due to start that on 8/6 just incase but I had a neurology apt scheduled on July 24th for over a month and discovered I had Idiopathic Intracranial Hypertension which is causing vision loss and my neurologist doesn't want me to wait that long to get the surgery. She is going to try to get my insurance to waive the 6 month diet which I hope they do. I have heard good things about BCBS though and them approving fast. SO just stay on top of it and it should work out.