? for Anthem BCBS Insured

My employer's corporate office is in Louisville, KY. Therefore my insurance provider is Anthem Access BCBS of KY. I have a few questions. Have any of you been successful in getting your wls covered by this insurance? Any suggestions? Do you recall an exclusion in your policy? I appreciate any help/insight you can give me. I have read the insurer's board but do not know if they have the same Access. My member # starts with YRP. Thanks, Beth

Mine starts with that also, and i have the same insurance, and I am trying to find people who have had it too, i went to the insurers board, (alot of anthem bc/bs's have approved this surgery) and emailed a couple people and one lady has been so nice. She told me she didnt have a problem getting approved. Keep in touch with me, so we can share what we learn. i know i havent helped you, but i will let you know what i find out. ok? take care Kim

My insurance is Anthem BCBS. It is a PPO and also has Blue Access written on the card. My member # doesn't start with YRP. It has letters that coordinate with the name of my employer. I have been approved and it only took about three weeks. Have you called your customer service line? I called them and found out it was a covered procedure once you jump through all the hoops (see next paragraph) and then they review it for approval. Ask them to read you the policy. I tried to be extremely friendly and polite and that seemed to help; however, they would not fax or mail me a written policy regarding the surgery. If I had been denied, I would have pursued that further. It seems to me if I'm paying for something, I ought to be able to get a paper copy of what's what. They wanted six months' documented weight loss efforts, psychological eval and nutritional eval. Dr. Bolar in Lexington required a sleep study and insurance covered that minus my 20% even though they didn't require it. I also have co-morbidities of diabetes and high cholesterol. My BMI is 43. The biggest hint I can give is get all the records you can get your hands on from your doctors and all your weight loss efforts. Be willing to pay a moderate price if they charge for copies. Keep a copy for yourself, highlighting any mention of weight, dieting or health problems due to weight. You may also want to write a biographical account of your weight problems just to get it all straight in your mind. Good luck.

I called today to see if they received my doctor's paperwork. Again, they asked me what procedure and I told them the gastric bypass. And again, they said absolutely not. It was my employer who has chosen this exclusion and they will not cover it whatsoever. By the time this is over, add depression to my list. Beth M

I have Anthem...the policy is "Blue Preferred," whatever that means. It is through the state (soon-to-be-ex-husband is a state employee). I had absolutely no trouble getting approved. I called the customer service line before I went to my primary care physician to see if the procedure was covered and was told it was as long as I had a referral from my PCP. I visited him and got the referral. All my time hold-ups came from the surgeons. The first one my PCP referred me to was no longer doing WLS. The next one (who ended up doing my surgery) was great, but I had a LOOOOOONNNNNGGGG waiting period from the time I filled out the paperwork (Oct.) to the time I had my consult w/ him (Feb.). It only took about 3 weeks for Anthem to approve me after my consult, but I chose to wait until May for the surgery because I'm a teacher and wanted to finish the school year. Anthem covered all pre-op testing, hospital expenses, and post-op follow-up (so far). Since my divorce will soon be final, I am anxious to see if the health insurance I'll be picking up through my employer will be as good about covering my continuing visits. Anthem was wonderful to work with, though!

Beth, could you speak to your employer about this? Someone in HR? Maybe with some persistence, you could get them to change the exclusion. It's worth a try.

Brenda, I have tried with them on two separate occasions. They are telling me that they are not given any choice as to what they want the policy to cover or not. That they are just handed the policy from the insurance company. I personally do not believe this. They are not willing to do anything for me. The insurance ended up denying me also.