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

Anthem Blue Cross PPO California - policy change?



Recommended Posts

Hello,
Looking for others that have Anthem Blue Cross PPO in California. At my initial visit with the surgeons office they instructed me to have 6 months of dietician visits. Anthem had sent me links to their policy document cg-surg-83 that (to my reading!) looked like 6 months wasn't required as of August 2020.

The policy states:

Documentation of all of the following:
Past participation in a weight loss program; and
Inadequate weight loss despite a committed attempt at conservative medical therapy (for example, comprehensive lifestyle interventions, including a combination of diet, exercise, and behavioral modifications); and

Also:

Revised 08/13/2020

Medical Policy & Technology Assessment Committee (MPTAC) review. Revised criteria requiring participation of at least 6 months in a weight reduction program. Revised not medically necessary indications to remove examples of devices which are no longer available. Updated Discussion and References sections. Reformatted Coding section.

I have all of my clearances except for another 2 months of dietician visits. What I'd like to do is ask my surgeons office to just submit to insurance now with the hopes that I will get surgery end of Feb/early March.

Has anyone got any recent experience I can draw on to help inform my decision and make my case!

Share this post


Link to post
Share on other sites

I also have Blue cross PPO and they only required three months where I filled out: How I was exercising, What I ate and how much weight I lost. Then I had to have my doctor sign it. Of course that's on top about 10 different test.

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

    • jparadigm

      Happy Wednesday!
       
      I hope everyone is having a lovely week so far! 
      It's been a bit of a struggle this last week...I'm hungry ALL the time.
      · 1 reply
      1. BlondePatriotInCDA

        Have a great Wednesday too! Sorry you're hungry all the time, I'm pretty much the same..and I'm sick of eating the same food all the time.

    • ChunkCat

      Well, tomorrow I go in for an impromptu hiatal hernia repair after ending up in the ER over the weekend because I couldn't get food down and water was moving at a trickle... I've been having these symptoms on and off for a few weeks but Sunday was the worst by far and came with chest pain and trouble breathing. The ER PA thinks it is just esophagitis and that the surgeon and radiologist are wrong. But the bariatric surgeon swears it is a hernia, possibly a sliding one based on my symptoms. So he fit me into his schedule this week to repair it! I hope he's right and this sorts it out. He's going to do a scope afterwards to be sure there is nothing wrong with the esophagus. Here's hoping it all goes well!!
      · 3 replies
      1. AmberFL

        omgsh!! Hope all goes well!! Keeping you in my thoughts!

      2. gracesmommy2

        Hope you’re doing well!

      3. NickelChip

        I hope it goes well! Sending positive thoughts for a speedy recovery!

    • jparadigm

      Hello lovlies!
      Today is a beautiful day in west Michigan! I hope you all have a beautiful Tuesday and rest of your week!! 🤗
      · 0 replies
      1. This update has no replies.
    • Clueless_girl

      Having gall bladder surgery in a few days and I so hope the recovery is easier than the one from the modified DS! I could use a bit of luck/pep talk for a change. I'm starting to be able to walk around without experiencing dizziness, but it would be great if the random pain in my chest and abdomen would go away!!
      · 0 replies
      1. This update has no replies.
    • Dawn 1974

      4/4/2024 - new patient orientation. Wt 313
      4/5/2024 - got all my lab work done.
      · 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

    ×