Any feedback on Anthem Insurance(PPO) in Indiana

Good Morning All, I have posted this once in the general message board, but found this Indiana forum (still learning about this site). I am looking for any feedback about Anthem PPO in Indiana as related to WLS. I have checked the "Insurers" page and just haven't found what I am looking for. I am looking for anyone that has had success (or declinations) or any way around the exclusion in receiving an approval for WLS with Anthem if they had the exclusion as stated below by Anthem PPO in Indiana. My Anthem PPO states in "Not Covered Services" section: "For bariatric surgery, regardless of the purpose it is proposed or performed. This includes but is not limited to Roux-en-Y (RNY), Laparoscopic gastric bypass surgery or other gastric bypass surgery (surgical procedures that reduce stomach capacity and divert partially digested food from the duodenum to the jejunum, the section of small intestine extending from the duodenum), or Gastroplasty, (surgical procedures that decrease the size of the stomach), or gastric banding procedures . Complications that result in an Inpatient stay or an extended Inpatient stay for the bariatric surgery not covered." Any feedback at all would be appreciated as my doctor has now put me on byetta (injections that I give myself twice daily for weight loss) and really don't want to have to do that for the rest of my life. My BMI is 49.2, I have been obese my entire life (37 years), have tried everything to lose the weight and now that I am getting older my body is really feeling it and I am terrified that I won't see another year. Please forgive me for being so "wordy", I just do not know what to do now. Many thanks ticklezngigglez

is it cover for a morbid obese person? that may be the way around this....not sure but worth checking into..the words MORBID being the key to get around the plain ole obese...but they are onto the ways around this maybe...damn insurances suck

I have federal BC/BS Anthem and it was covered. I know they have some less expensive policies they offer employers to help reduce the health insurance rates. Sounds like you may have one of those policies Good luck on your journey...all you can do is have the bariatric center of your choice submit your package and have them deny you-then start the appeals process.

The exclusion reads as if it is less like Anthem's exclusion and more like an exclusion in your/spouse's policy that the company elected to take. It wouldn't hurt to try the whole "morbidly" part of getting around the exclusion; however, from the way I understood it, they are not saying for obesity or morbid obesity in that exclusion - they are saying they won't cover it at all. I have read on here a lot where people say to appeal based on the morbid not being in the exclusion, but I honestly think that in the 6 years I've been reading these boards, I rarely have seen anyone win based on this. It sounds like to me that the appeal is going to have to be at the company's level - since it looks like they elected to take this exclusion. Good luck to you!