Looking for other Anthem Blue Cross PPO experiences.

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My company was bought and our insurance will change to Anthem Blue Cross in January. The plan is called Prudent Buyer. My new employer is California based however I live in Texas. We haven’t enrolled in our selected plans yet however my HR person gave me the EOC for this year explaining all the coverage and stated nothing will change. Bariatric is covered and the only stipulation is that it must be deemed medically necessary and performed at a BDCSC facility. There are absolutely no other requirements listed like wait times, nutrition visits, etc. Anyone else have experience with this plan?

[fitasafiddlehealth 1]

So when I had my band placed in 2009 I had to prove what diets I had already been on, a psychological evaluation and all the physical stuff. Then In 2016 when I had my gastric bypass done I just had the doctor handle things. They wanted to make sure it was medically necessary for the revision. They paid all but 20 percent or up to my out of pocket max which I believe is $2800. Hope this helped!

[lisamaemac 1]

I just had my surgery on Monday. My insurance told who to see as a surgeon. 6 mo appt with a nutritionist, a psych evaluation, gastrointestinal evaluation

Sent from my SM-G960U using BariatricPal mobile app

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1 minute ago, lisamaemac said:

I just had my surgery on Monday. My insurance told who to see as a surgeon. 6 mo appt with a nutritionist, a psych evaluation, gastrointestinal evaluation

Sent from my SM-G960U using BariatricPal mobile app

Interesting...and you have Anthem BC non-CA resident PPO in Texas?

[Walter Lindstrom 42]

Hi Kimmie K,

I believe this link to Anthem's updated bariatric surgery medical policy is exactly what you are looking for: CG-SURG-83 Bariatric Surgery I'm also attaching it as a PDF. This contains all the Anthem req'ments as of their October 31, 2018 update. Hope this helps!

CG-SURG-83 Bariatric Surgery and Other Treatments for Clinically Severe Obesity.pdf

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1 hour ago, Walter Lindstrom said:

Hi Kimmie K,

I believe this link to Anthem's updated bariatric surgery medical policy is exactly what you are looking for: CG-SURG-83 Bariatric Surgery I'm also attaching it as a PDF. This contains all the Anthem req'ments as of their October 31, 2018 update. Hope this helps!

CG-SURG-83 Bariatric Surgery and Other Treatments for Clinically Severe Obesity.pdf

This is exactly what I have not seen yet. Thank you so much!!!

Edit: When you posted this https://wlsappeals.com/2792/walters_bariatric_surgery_blog/supervised_diet_requirement_eliminated/ ...do you think my plan falls under that? I won't have Anthem until January so I don't have the ability to call on the plan and my new HR lady is a tad not up to speed with the particulars of the plan...

Edited November 15, 2018 by Kimmie K

[Walter Lindstrom 42]

I wouldn’t expect changes when 2019 rolls in since this is a recent update, but make sure you keep tabs on it just to be sure! 👍🏻

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4 minutes ago, Walter Lindstrom said:

I wouldn’t expect changes when 2019 rolls in since this is a recent update, but make sure you keep tabs on it just to be sure! 👍🏻

Awesome! Thanks a ton