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

Anthem BCBS denied my surgery [emoji22]



Recommended Posts

My surgery is already scheduled for July 31st. I received a letter from my insurance company, Anthem BCBS on Friday denying my request for my sleeve surgery. They claim I have not met all my requirements which I have. I've been under my surgeon's care since December. I have met all my surgeon's requirements. BCBS is saying I have not been on a supervised diet for 6 months. I plan to appeal their decision but this could not have happened at a worse time for me. I just found out I have 60 days to move!! Its been very stressful the last few days. I'm super bummed and feeling frustrated and overwhelmed by everything [emoji24]. I've worked so hard to come this far and to get all of this bad news at once. I'm praying everything works out as it should. I'm so depressed.

Sent from my [samsung Galaxy] using BariatricPal mobile app

Sent from my [samsung Galaxy] using BariatricPal mobile app

Share this post


Link to post
Share on other sites

Have you been on a supervised diet w the bariatric nutritionist? If you have then someone did not submit it properly. Did they have a diet plan?Record your weigh-ins? And your progress?

Did they submit monthly? There are rules that insurance has on when submissions need to be done - if the surgeon's office did not do this then they have some explaining.

Take a deep breath. Talk to the insurance submission person at the bariatric clinic - and have them CALL BCBS and talk to the intake person there and find the issue. Do this in person at the bariatric clinic - not on the phone - the surgeon's office will be very motivated to get it corrected. At the worst your surgery could get delayed.

In the meantime, carefully follow the appeals process. Be diligent in following up with the corrected submissions.

Share this post


Link to post
Share on other sites

Yes, I had monthly visits with my surgeons office for weigh ins and to discuss my diet and exercise goals. I also seen a bariatric nutritionist my surgeon recommended on a few occasions. I followed all of the instructions I was given. Due to my ongoing medical issues and hospitalizations, I have been in the covered phase of my insurance for a couple of months. I plan on speaking to my surgeons office Monday morning and filing the appeal. It's just disheartening to come so close and having a date finally then getting the bad news. Plus all of the other things I'm having to deal with. I'm so overwhelmed.

Share this post


Link to post
Share on other sites
Yes, I had monthly visits with my surgeons office for weigh ins and to discuss my diet and exercise goals. I also seen a bariatric nutritionist my surgeon recommended on a few occasions. I followed all of the instructions I was given. Due to my ongoing medical issues and hospitalizations, I have been in the covered phase of my insurance for a couple of months. I plan on speaking to my surgeons office Monday morning and filing the appeal. It's just disheartening to come so close and having a date finally then getting the bad news. Plus all of the other things I'm having to deal with. I'm so overwhelmed.
Keep your head up. They will figure it out. I have BCBS and the denied me as well. They said it was because I haven't quit smoking for over 6 months. If it gets pushed back it's going to be a pain I understand but don't let it dishearten you because then the insurance company will win and not have to pay for it. I'm sorry it happened to you but don't let this speed bump ruin your whole ride.

Sent from my ONEPLUS A5010 using BariatricPal mobile app

Share this post


Link to post
Share on other sites

Thank you, I not going to give up this easy after all the money and effort I've invested. Its just sad and frustrating to have to jump through all the hoops but I know I need to and it will be so worth it!

Sent from my [samsung Galaxy] using BariatricPal mobile app

Share this post


Link to post
Share on other sites
4 hours ago, Flo-grown said:

Yes, I had monthly visits with my surgeons office for weigh ins and to discuss my diet and exercise goals. I also seen a bariatric nutritionist my surgeon recommended on a few occasions. I followed all of the instructions I was given. Due to my ongoing medical issues and hospitalizations, I have been in the covered phase of my insurance for a couple of months. I plan on speaking to my surgeons office Monday morning and filing the appeal. It's just disheartening to come so close and having a date finally then getting the bad news. Plus all of the other things I'm having to deal with. I'm so overwhelmed.

I have BCBS as well but I was told my 6 months had to be with someone other than my surgeon. BCBS of GA doesn’t cover at all, but my husbands company is out of another state which DOES cover (PTL!)... don’t know if this is an insurance requirement or something my surgeon requires.

Share this post


Link to post
Share on other sites
I have BCBS as well but I was told my 6 months had to be with someone other than my surgeon. BCBS of GA doesn’t cover at all, but my husbands company is out of another state which DOES cover (PTL!)... don’t know if this is an insurance requirement or something my surgeon requires.
I should have been made aware of this from day 1. Hopefully my surgeon will know more about it on Monday. I'm praying it's something minor.

Sent from my [samsung Galaxy] using BariatricPal mobile app

Share this post


Link to post
Share on other sites
13 minutes ago, Flo-grown said:

I should have been made aware of this from day 1. Hopefully my surgeon will know more about it on Monday. I'm praying it's something minor.

Sent from my [samsung Galaxy] using BariatricPal mobile app

Agreed! I hope you find your answer!

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

  • Recent Topics

  • Most popular:

  • Recent Status Updates

    • Krestel

      I just looked through all my old pants after my pre-op pants started getting to big. Keep in mind that I wear men's pants (usually cargos) because I am so tall 5'10"/5'11" ish. I also find that men's baggies tend to fit me better.
      I started out at a 44 in waist pant and quickly found that I was back down to my 42's. So even when thise got to be too big, I had to start pulling old clothes out of storage. After finding my 38's, I thought that these would not yet fit, but when I tried them on, they fit perfectly. I also found some older pants that now fit better than I remembered. What a relief! It's not like I can pop down to the store like I could do in the US and the styles here in Sweden are all skinnt jeans which I cant stand. I also found some 36's, but I'm not mentally ready to try those on yet. The biggest challenge will be buying women's clothing again. 
      · 0 replies
      1. This update has no replies.
    • allwet

      slow and steady wins the race.  don't get discouraged and just keep at it. Let your sleeve do its job and try not to stress yourself out.
      hope you are all having a great summer and enjoying what your sleeve has given you.
      just got back from a wedding in OR. and man am i afraid to get on the scale  
      · 2 replies
      1. Orchids&Dragons

        Fascinating! Thank you!

      2. Krestel

        Great reminder about how fast you can lose weight. The mind games we play with ourselves are the worst.

    • TinaLeo  »  mombrown35

      I had ESG on July 1st down  15 lbs at weigh in July 11th
      · 0 replies
      1. This update has no replies.
    • debra102364

      The future belongs to those who believe in the beauty of their dreams
      Eleanor Roosevelt
      · 0 replies
      1. This update has no replies.
    • Lynda486

      · 0 replies
      1. This update has no replies.
  • Trending Topics

  • Together, we have lost...
      lbs
    ×