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Anthem Blue Cross Hints



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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!!!!!:)

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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!!!

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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!

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

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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

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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?

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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

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Guest BikiniBeachy

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

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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 by Lana24

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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

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    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 0 replies
      1. This update has no replies.
    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

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      Officially here for a long time, not just a good time💪
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    • KimBaxleyWilson

      Three months and four days ago... I was in Costa Rica having a life changing surgery! Yesterday we had a followup visit with Dr. Esmeral via video chat and this morning my middle number changed.  I'm down 47lbs and two pants sizes. I can wear a Large tshirt for the first time in like... 14 years! Woot!! Everything is going great. I have zero regrets. I went down to the riverwalk with a friend and walked 2 miles on Monday without even getting fatigued. And no more snoring or chugging pickle juice for crazy leg cramps! I need to go to the gym more... I'm making new shirts next week so that will motivate me. LOL But I'm also just not as TIRED all the time! I have a LONG way to go...but seeing the progress on the scales and in the mirror is a huge motivator!! Thank you all for cheering me on and supporting me!!
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      https://alluniqueguide.com/java-burn-coffee-reviews/
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