And yet another brick wall...........

Hello all....Everyone here is so supportive and understanding, you also all have great insight on this whole frustrating process. When I started this process I had Connecticare as a HMO provider. I had all of my pre-surgical testing done by 12/31/04 last year and it was all covered. In January my husband's new PPO kicked in (Anthem BC/BS). I was having trouble getting my BMI down to an acceptable point for St Francis, so I reached out to you all and got some great leads. In August I met with Dr Giles at UCONN and things looked good to go once I get the OK from his nutritionist. He sent me for some additional bloodwork and I am going to meet with the nutritionist this week. Here's the problem. I just got my statment from Anthem for the bloodwork....NOT COVERED!!!!!! Called them up and come to find out this particular plan (Century Preferred) does not cover morbid obesity treatment.... AT ALL. Has anyone dealt with Anthem in terms of requesting coverage/appeals? Am I looking at months and months of fighting with them? Thanks for letting me vent.........Linda

I don't know much about Anthem BC/BS, but from what I have heard from others is that most insurance companies with these exclusions willl end up covering treatment (including surgery), but it is usually a long appeals process.

Hi Linda! I have Anthem and they covered everything (just not the co-pay and the $250 hospital co pay). I would call and ask to speak to someone higher up, also have your Doc office call and see whats up. I heard that Anthem was one of the best insurance to have if you were doing W/L. Best of Luck !!!!!!!!!! Carmen

Linda, I am so sorry to hear that you are having trouble with insurance coverage. You have come so far to get this surgery and it just doesn't seem fair that you have hit another snag. I am hoping that you don't have to stuggle too much with your ins. carrier and that they will cover your surgery so you won't be delayed any further. (((BIG HUGS)))) Terri

Thank you all for your words of encouragement. I will let you all know of any new developments. I am going to see if I can speak to whomever it is that submits the approval requests for Dr Giles' office to see if they have any advice. Again, Thanks!!!! You are all Linda

Hi Linda, I have Anthem and everything was covered at 100%. The only items that didn't get covered were the psych eval and nutrition eval pre-surgery. As far as anything to do with the surgery, it was all covered at 100% (hospital). Dr.'s visits I pay my co-pay of $10. Good luck! Appeal appeal appeal! Check with your doctor's office too; they know which plans cover what. JA