Hello everyone,

I am new to this site and have been looking through to find help with appeals. I have been denied 3 times by Anthem BC of California. I have a BMI of 59, high BP, diabetic and they keep saying telling me I don't meet their criteria.

Is there no hope as long as I am with them? I have not seen anyone talk about success with them just the horor stories. If you have had success or can give suggestiong about appeals I would greatly appreciate it because I am getting discouraged.

Thank you in advance

d

Insurance is very complicated and frustrating. Why don't you call your insurance customer service number, give them your policy number and tell them you are contemplating WLS and want to know EXACTLY what their requirements are, such as miminum BMI, co-morbidities, any pre-op diet program or number of years of weight loss information and anything else you can think of. Don't tell them your name or than you've been denied. Then in a day or two, once you've reviewed everything that was ACTUALLY SENT IN TO THEM, call them back and ask what else they need in order to approve your claim on appeal. I don't know what else to suggest.

I agree with Parrothead, you need to find "exactly" what your insurance company requirements are to qualify. In your denials, they should have told you why were denied. They are required by law to inform you. I find it hard to understand with your BMI and diabetes and blood pressure that you don't meet the requirements, but insurance companies will do anything they can sometimes to deny claims. is your Primary Care Physician supportive? Some insurance companies have a six-month plan which include group sessions, psyche eval, a certain percent weight loss. So you can't begin to move forward until you know what requirements are and why they denied. Have you appealed to your medical state board. You can always go over your insurance company and go to the state board, especially if they won't give you a reason for denial. Then last resort, hire an attorney that handles medical appeals.

Good luck

Trisha

I have Anthem BC of CA, and had no problems with getting approved. They required a Psych eval, and a nutritionist assessment, but no supervised weight loss programs or anything like that. I called them and they sent me the information on Weight Loss Surgery. You need to call them and have them send you that. Also, they should of sent you reasons for rejection. You definitely have enough to qualify unless they have something very specific with the insurance plan that you have.

My paperwork went to Anthem two weeks ago today (and counting!!!) I'll post when I get a decision. I have a BMI of 40 and no comorbid issues. Anthem e-mailed me the requirements and the clinic I am using verified I only needed a bmi of 40, phyc eval, nutrional assement and a letter from my primary. I just made the stated critera and had all three letters were sent in. We'll if they will approve.

I have Anthem BC of AZ, my company home office is in CA and I was approved in 7 days with no 6 month diet... But my husband has been waiting since April 29th to hear if he is approved or not... our paper work was sent in within days of each other... You may want to find out if your employer specifically excludes weigh loss surgery. They can do that. With what you listed you would qualify.

Good Luck!

I received my appoval letter from BC Anthem in the mail (SURPRISE!!!). The clinic is closed until Tuesday(Memorial weekend) I am assuming they have the same letter. The date on the letter was five days after my paperwork went in. In total I waited less than three weeks.