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

Anthem BCBS, Illinois



Recommended Posts

Hello, all.

A bit nervous with my first post. It's been less than a week since I got a new general practitioner (the previous one retired) and formally raised the idea of (probably) gastric bypass surgery. I haven't done any of the consultations, finding a surgeon, etc, that's all in the future. But one thing I can worry about and start to plan for in the present is insurance.

I am in Illinois and have Anthem BCBS.

Something I see listed on their requirement is:

  1. Past participation in a weight loss program; and
  2. 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

Anyone have any experience with that, or with Anthem BCBS? Because to my skeptical eye that just looks like a catch-22 way to deny the claim: "Oh, you lost weight? Don't need surgery, then, do you? Oh, you didn't lose weight? Not committed, I guess. Tough luck, though."

Share this post


Link to post
Share on other sites

pretty much all insurance companies have those same requirements, and most of us were approved as long as we met the BMI requirements (which are typically BMI over 35 with two comorbidities, or BMI over 40 with no comorbidities.

they're looking for whether or not you've tried things in the past that haven't worked. And with the six-month professionally-supervised diet that many companies require before your final approval, they're looking to see if you're able to stick to a program long-term.

I lost 57 lbs before I had surgery (between the six-month professionally-supervised diet that my insurance required - and the two week pre-op liquid diet that my surgeon required). I was approved. I was worried they'd say since I lost weight on my own, I didn't need surgery - but that wasn't it. They wanted to see how committed I was to a program.

Share this post


Link to post
Share on other sites

Thanks, Catwoman7, that's somewhat reassuring and when put that way there is a certain logic to it.

Right now, I think my BMI is 41 (I know my weight, but it's been so long since someone measured my height I'm honestly not sure if I remember it accurately!) so I'm also a little concerned that if the diet works, I'll dip below the threshold for insurance coverage.

PS - Kudos on losing all that weight with the diet, though. Like most of us (I'd think) I know what kind of incredible achievement that is.

Share this post


Link to post
Share on other sites

When I applied to have surgery they measured my height and I had lost an inch since when I was a teenager. It bumped up my BMI and helped qualify me for surgery.

Who knew you can get shorter?! 😅

Share this post


Link to post
Share on other sites

Scientist, where did you find their requirements? I’ve looked and can’t find them

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

    • Theweightisover2024🙌💪

      Question for anyone, how did you get your mind right before surgery? Like as far as eating better foods and just doing better in general? I'm having a really hard time with this. Any help is appreciated 🙏❤️
      · 2 replies
      1. NickelChip

        I had about 6 months between deciding to do surgery and getting scheduled. I came across the book The Pound of Cure by Dr. Matthew Weiner, a bariatric surgeon in Arizona, and started to implement some of the changes he recommended (and lost 13 lbs in the process without ever feeling deprived). The book is very simple, and the focus is on whole, plant based foods, but within reason. It's not an all or nothing approach, or going vegan or something, but focuses on improvement and aiming for getting it right 80-90% of the time. His suggestions are divided into 12 sections that you can tackle over time, perhaps one per month for a year if a person is just trying to improve nutrition and build good habits. They range from things like cutting out artificial sweetener or eating more beans to eating a pound of vegetables per day. I found it really effective pre-surgery and it's an eating style I will be working to get back to as I am further out from surgery and have more capacity. Small changes you can sustain will do the most for building good habits for life.

      2. Theweightisover2024🙌💪

        That sounds awesome. I'll have to check that out thanks!

    • BeanitoDiego

      I've hit a stall 9 months out. I'm not worried, though. My fitness levels continue to improve and I have nearly accomplished my pre-surgery goal of learning to scuba dive! One dive left to complete to get my PADI card 🐠
      I was able to go for a 10K/6mile hike in the mountains two days ago just for the fun of it. In the before days, I might have attempted this, but it would have taken me 7 or 8 hours to complete and I would have been exhausted and in pain for the next two days. Taking my time with breaks for snacks and water, I was finished with my wee jaunt in only 4 hours 😎 and really got to enjoy photographing some insects, fungi, and turtles.
      Just for fun last week, I ran two 5Ks in two days, something I would have never done in the past! Next goal is a 10K before the end of this month.
      · 0 replies
      1. This update has no replies.
    • Teriesa

      Hi everyone, I wrote back in May about having no strength. I still get totally exhausted just walking from room to room, it’s so bad I’m using a walker with wheels of all things. I had the gastric sleeve Jan. 24th. I’m doing exactly what the programs says, except protein shakes. I have different meats and protein bars daily, including vitamins daily. I do drink my fluids as well.  I go in for IV hydration 4 days a week and feel ok just til evening.  So far as of Jan 1st I’ve dropped 76 lbs. I just want to enjoy the weight lose. Any suggestions or has anyone else gone thru this??  Doctor says just increase calorie intake, still the same. 
      · 0 replies
      1. This update has no replies.
    • Stone Art By SKL

      Decorative Wall Cladding & Panels | Stone Art By SKL
      Elevate your space with Stone Art By SKL's decorative wall claddings & panels. Explore premium designs for timeless elegance.
      · 0 replies
      1. This update has no replies.
    • Clueless_girl

      Losing my hair in clumps and still dealing with "stomach" issues from gallbladder removal surgery. On the positive side I'm doing better about meeting protein and water goals and taking my vitamins, so yay? 🤷‍♀️
      · 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

    ×