Anthem BCBS, Illinois

[Scientist 0]

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."

[catwoman7 10,856]

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.

[Scientist 0]

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.

[ClareLynn 153]

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?! 😅

[Neonurse 0]

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