Insurance

I just got very expensive insurance (Anthem) at work that I really can't afford as a single mother in hopes of having gastric bypass surgery. I checked the Dartmouth-Hitch**** Portsouth Hospital, and St Joseph's Hospital web site before I signed up, checked the insurance information, and thay all said they accept Anthem. Now I am hearing from people that Anthem doesn't cover it. I tried calling Anthem and they said I would need a surgery code before they could check to see if I am covered. Does anyone have experience with Anthem? Thanks!!! Carrie

Hi Carrie, Sorry to be the bearer of bad news, but I was talking to the coordinator of my surgeon's program about Anthem last time I was in. Unless your company specifically bought a very expensive rider, Anthem stopped covering the surgery in NH the first of the year (or as the policies came up for renewal). Your HR department would know for sure. I got a booklet with the changes to my coverage this year and it specifically stated that WLS was no longer covered. All the surgeons in NH are fighting this together at the state house. Best of luck, Kathy

Hi Carrie, I strongly encourage you to contact Dr. Drinkwater in Nashua. He is the founder of The Obesity Center and is a phenominal surgeon. Jen, his office coordinator, is awesome. She will take care of calling your insurance company and finding out how you can get this approved. Their program is awesome. The phone number is 577-5757. Call and Jen will send you a packet. You fill it out, send it back, then they call and schedule you for a meet and greet with Dr. D, and a new patient seminar. The process with Dr. D's program is incredibly smooth. Dartmouth Hitch**** unless they have improved dramatically, is terrible. See my profile for details. I started out with Dartmouth and am so glad I switched! My friend, who is also a post-op of Dr. D's, also started with Dartmouth and she had the same bad experiences as I did. While it is true some Anthem plan have stopped coverage, you never know unless you try. Contact Jen at Dr. D's. You will be so glad you did! I will go get that code you are talking about in the meantime and come back and post it. Click on the profile tab on my post so you can read about what happened with DHC and how Dr. Drinkwater's program runs. I was pretty detailed about my experiences. Hugs, Denise

Denise! I almost didn't recognize your picture. You look amazing! How are you feeling? The stomach better? Pat

Hi Carrie, Okay, here are the codes you need. I am assuming that you are looking into the RNY, otherwise known as "gastric bypass". That is the one I am posting the codes for. If you want the code for DS or Lap-Band, let me know. Thought keep in mind, if your insurance covers weight loss surgery at all, they will most likely only cover the RNY/Gastric Bypass. Very few cover the band or DS. You can appeal and try that route, of course, but if you are going for the RNY, you have a much better chance of approval. The CPT code for the open RNY is 43846. There is no code specifically for the lap RNY, but I have seen 43847 posted for lap RNY. When you call your insurance company, give them the 43846 first and go from there. If they cover open, they most likely will cover Lap, so leave this for the surgeon's office to figure out. If yu give them the open code and they say it is approved if deemed medically necessary, you are golden! Let us know how you make out. Hugs, Denise

Thanks for the advice! I am just concerned that I am making these appointments, for which I will have to miss work, and then this will not be something I am able to do. I will be heartbroken! I have wanted this for so long, but always thought it was for rich people and would be an out-of-pocket expense. Before I signed up for the Anthem Insurance, which just went into effect yesterday, I checked, becasue this was the only reason I wanted insurance. Generally I avoid doctors decause of my weight and the embarassment, and have seen only obstetricians since I was 16, never a family practice doctor. I did have one consult with an endocrinologist due to sores on my feet in pregnancy due to gestational diabetes. Other than that, for any health concerns, I have been forced to go to the ER. I do, however, have diet attempts going back to age 11, including starvation, Atkins, Weigh****chers, and 3 summers at Fat Camp. I have been at my job about 3 years, but did not buy the health insurance before because it was too expensive and it was not "real" insurance. We were self-insured, and, from what I understand, it means that your employer, not your doctor, has the final say over procedures like this, and I know my boss would never go for it is he was paying. He even encourages people to limit radiation treatments for cancer. In addition to my desire to be more active with my family (I have not been to an amusement park since I was 17 and had to cross by legs to get the bar to close on a ride) and more comfortable in my day-to-day functions, I am very concerned about my health as I get older. I am now 32, and no one (save my mother, thankfully) in my mother's family has lived past 45, not grandparents, great-grandparents, aunts, uncles, even great aunts and uncles. Everyone has dies from strokes, heart disease, complications of diabetes. My grandfather dies of a stroke at 29, and my mother had her first stroke at 36. I guess I do not need to convince you guys, but it seems to me that, clearly, in my case, weight is a life-threatening problem. Incidentally, I was researching Anthem's new regulations on the internet, and I read somewhere that the new regulations apply only to companies with less than 50 employees. We have about 150, and 94 who are on the insurance, so there is still a glimmer of hope. Denise, by the way, you look absolutely beautiful! Congratulations and good for you! Thanks, Carrie

Incidentially, my premiums for the insurance are $66.15 per week for a single person. If I would've gotten family coverage, it would've been $151. Doesn't that seem like a lot? When I lived in Massachusetts I paid less than $25 per week for BCBS, Delta Dental and Vispa Vision for the family plan. Yikes! Health care sure is expensive here! I also know that in Massachusetts, single parents can get Medicaid for themselves and their children, but apparently in NH, adults can only get Medicaid if they have a disability. How terrible! I am sure Medicaid probably covers this, it seems like they cover everything. I guess I am the loser for going to work every day like a chump.

Anthem insurance here in NH is very expensive, they probably all are I can only speak about them. I've had it for a number of years and have seen increases every year. The news that Anthem will no longer be covering wls was, to me, outrageous. I belive that Cigna, another major carrier in our area also made that decision. As Denise said, Jenn is wonderful and would be able to answer your questions. At one of the support meetings she had said that the docs in the area were trying to fight the insurance companies. She had suggested writing to the state legislature in protest. So, maybe things might change Best wishes. diane

Thanks Diane! I have just written letters to the state Insurance Commission, the Legislature and Anthem. I am quite a good letter writing, and fairly convincing. I tried to appeal to them on both an emotional and financial level, stating that the cost of gastric bypass is much less than treating chronic health conditions related to obesity. I also used articles on their web sites that supported gastric bypass as weight control and why it was more effective than drugs and diets. Hopefully, it will help. I will just keep writing letters and annoying them, and in the meantime, rack up medical bills.

HORRAY FOR ME!!!!!! I have been so upset about Anthem not covering my surgery. I just called the insurance company and gave them the surgery code, and they told me it was covered with prior approval. So, I guess as long as the surgeon gets approval before they surgery, they will pay, and cover related expenses. I guess they are only dropping coverage for companies with fewer than 50 employees. I am so grateful. I guess i better do this quick before they change their mind. I am going to Manchester seminar on Fri and Nashua on Tues. Good luck to me!