[rkvincent]

I will have Anthem Blue Cross of CA (PPO) starting Jan 1,2011. Has anyone had this kind of insurance? Any advice, tips?? I hope they are one of the easier kinds of insurance to work with!!

[NOLAgrl]

I have Anthem (National) Blue Cross PPO and didn’t have a problem getting approved for my surgery. One thing you have to find out of the surgery is covered under your plan. Good luck in your journey!!

[Cyndie]

Me too! Agree with the above post. I had no problems getting approved being 100 lbs overweight. But not all plans cover it.

[rkvincent]

This is very encouraging. The plan I have will pay for the surgery, as long as all the "medically necessary" requirements are met. I was just wondering how long the approval takes, after everything has been submitted to the insurance company.. I will feel alot better when I get approved for surgery.

[judijo]

I have Anthem Blue Cross HMO and had the surgery without a problem.

But your employer can put riders and exclusions in their policies, so you may want to check with Anthem for a copy of the plan with exclusions listed.

[NOLAgrl]

My approval was quick within a week or two, but I think it all depends on your surgeons office providing all the needed paperwork to Blue Cross. My hold up was the pych's office not providing the paperwork to my surgeons office in a timely manner, had the visit done in March and they didn't provide until July!!
My husband is in the process of getting the necessary preapprovals to have surgery done sometime next year, just praying they don't exclude the surgery on his plan.

[katress]

weird...i just got out of my benefits meeting and i was just reading this thread and i JUST signed up for the Anthem Blue Cross...

[Ang6425]

I have BCBS-IL and they had some crazy "hoops" to prove medical necessity, but the approval only took about 2 days! Good luck! Call a lot and stay on them for exactly what you need to do.

[AnneG]

rkvincent- We are switching from Cigna to Anthem as well starting Jan 2011 and
like you we have no idea what the plan covers because it hasn't been submitted for
us to review yet.
I'm really on edge about it because I'm making all these plans to have the surgery
and really hope to not meet a huge obstacle such as non coverage.
I'll be checking back on this thread for updates and hoping we find out some news soon.

[rkvincent]

Hi Anne, Welcome to RR. This is what I know so far of Anthem Blue Cross, (a co-worker with Anthem had RNY done this year and had all the requirements and saved her paperwork) Here is the document outlining the requirements:

Medically Necessary:

Gastric bypass and gastric restrictive procedures with a Roux-en-Y procedure up to 150 cm, laparoscopic adjustable gastric banding (for example, the Lap-Band® System or the REALIZE™ Adjustable Gastric Band), vertical banded gastroplasty, or biliopancreatic bypass with duodenal switch as a single surgery, is considered medically necessary for the treatment of clinically severe obesity for selected adults (18 years and older) who meet ALL the following criteria:

1. BMI of 40 or greater, or BMI of 35 or greater with an obesity-related co-morbid condition including, but not limited to:
   • diabetes mellitus; or
   • cardiovascular disease; or
   • hypertension; or
   • life threatening cardio-pulmonary problems, (e.g., severe sleep apnea, Pickwickian syndrome, obesity related cardiomyopathy); AND
2. The individual must have actively participated in non-surgical methods of weight reduction; these efforts must be fully appraised by the physician requesting authorization for surgery; AND
3. The physician requesting authorization for the surgery must confirm the following:
   • The individual's psychiatric profile is such that the candidate is able to understand, tolerate and comply with all phases of care and is committed to long-term follow-up requirements; and
   • The candidate's post-operative expectations have been addressed; and
   • The individual has undergone a preoperative medical consultation and is felt to be an acceptable surgical candidate; and
   • The individual has undergone a preoperative mental health assessment and is felt to be an acceptable candidate; and
   • The individual has received a thorough explanation of the risks, benefits, and uncertainties of the procedure; and
   • The candidate's treatment plan includes pre- and post-operative dietary evaluations and nutritional counseling; and
   • The candidate's treatment plan includes counseling regarding exercise, psychological issues and the availability of supportive resources when needed.

My plan in particular is also requiring a medically supervised diet that has been documented for six consecutive months. As a precaution, I have also went to my PCP and obtained the last 5 years of medical records, just in the event that they will want this. I am trying to do everything possible now,so when Jan 1, 2011 comes around, I can have the WLS center submit my info to Anthem and hopefully get approved, then get an appointment with my surgeon and GET A DATE!!!
Here is the link for Anthem -http://www.anthem.com/ca/medicalpolicies/policies/mp_pw_a053317.htm