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

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

    • amazingmimi

      I feel like I've finally gotten past the biggest hurdle. Surgery date is September 6th, the day after Labor Day, and yesterday I got my insurance approval letter. I've followed everything they've told me to do, and I've even lost 30 lbs on my own since hubby had to change his diet for diabetes. No worries now about having to do 4 weeks of the liver shrinking diet instead of 2. On my initial visit, if I had gained just 5lbs I would have had to do 4 weeks. It's getting closer. Just 2 more months to wait.
      · 1 reply
      1. NmMd

        Although the prep work took energy, I found the biggest hurdle was post-operative. The first 48 hrs were extremely uncomfortable. I did an overnight and trying to down the liquids, Tylenol, and especially the barium was rough. Thankfully though, I got away with only having to have 1 belly injection after surgery. Needless are not my thing.

    • Grace1234

      I am brand new to this my surgery is tentative for July 27 depending on insurance and I'll be have the Gastric Sleeve.
      · 0 replies
      1. This update has no replies.
    • Pepper1

      I am looking for people to connect with that are 4-5 years out. Many of the support sights I go to are all newbies. And while I enjoyed that when i first had my surgery and found it useful, I am looking to exchange ideas with folks that are out a few years. I am slowly gaining weight back and losing my excitement. I don't want that!
      · 1 reply
      1. SleeverSk

        Maybe post in the forums. It's a more active areaI have noticed no one replies to status updates

    • SuziDavis

      I have a surgery date! I am getting sleeved on 8/17/2022!
      · 0 replies
      1. This update has no replies.
    • Mudh8r

      How do you stay focused? I'm struggling a bit the past three days.  All I want is sweets and carbs.  I have no clue what changed but for some reason I'm craving hard.  I'm literally dreaming about food and when I wake up, I'm thinking about my next meal.  I'm not "hungry" but so munchy.  I'm trying to stay focused, busy, exercise and the likes but this looking struggle is getting to be so hard.  I meet with my nutritionist tomorrow and I'm so hopeful she has some advice.  My protein intake is great, liquids on point, even throwing in some raw veggies and berries to curb the sweet/carb craving.  Thoughts?
      · 1 reply
      1. SleeverSk

        I am like this at the moment too, maybe post in the forums and not as your status update you will get more 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

    ×