If I was told by one customer service rep that Lap Band was not covered by our policy, (Anthem BC/BS) Does any one have any good advice on what to do next? Does no always mean no? Can it be challenged by arguing for a "medical nessecity" plea. ( BMI is 40, Have History of very high blood preasure,joint pain. All my siblings have diabetes and heart disease.) I'm so ready to get started, any good advice would be so appreciated!!!!!

I have Anthem BCBS, and WLS is excluded from my plan unless medically necessary. When the surgeons office called my insurance they flat out said no it is not covered, failing to mention unless medically necessary. So I called BCBS and they gave me a Utilization Rep's number for my surgeons office to call. Today, I recieved a call from surgeons office and they are submitting paperwork for approval. Please don't give up, read carefully through your plan and keep calling BCBS untill you get the answers you want. GOOD LUCK!!!

Thanks for this info! I too was told NO by Anthem but, they haven't met Shadow...I am NOT a quitter until I get the answers that I want!! lol I will be on the phone with them again tomorrow!

I was denied twice by Anthem Blue cross of Ca..in the process of appealing. Good luck to all

Good luck to you all!

I work for Anthem, and believe it or not they cover WLS surgery. I have to fork out 10% co-insurance. I am calling to setup my consultation with the doctor....wish me luck

Dacoz21

DAC,

Since you work there I have a question, if you have a bmi of 35- up and you have hypertension, is it covered? Or is there some weird rule that you need to be on 2 or more meds, or have had HBP for a certain length of time?

I dont work in the customer service dept, however it really goes by what your rider states. Most of the riders that I have seen say that you must have a BMI of 35 with a medical cond. If you have a 40 or high you will also qualify.

Dacoz

Which Anthem policies completely exclude the surgery? I'm looking to get a really cheap Lumenos one but want to get the cheapest that includes bariatric surgery (with medically necesity though) thanks

Thanks DAC,

I found the problem, the docs office submitted the claim but there was vital info missing, that is why I was denied...when I last saw them my bmi was 40 and I have HBP... and to top it all off the doctors office straight up lied to me and said they have not received an answer...the insurance answered the request within 2 days... I am really frustrated at this point.

Edited April 1, 200818 yr by Lana24

I just called my insurance company Blue Cross Blue Shield TX - I live in Springfield MO and they said that my corporate policy has an exclusion that does exclude anything with a diagnosis code of 'obesity'...i may be in trouble for any of the other hundreds of things i have wrong with me then because i am sure 'obesity' is in there somewhere