Needing help w/insurance...have no idea what I'm doing

I need so much help or advice. I have been researching wls for about 3yrs but I have never went as far as to checking out the insurance. I am almost positive I can get it, I remember reading it in my benefits booklet. I have Anthem BCBS PPO.  My problem is when I call what do I need to say or ask,  Or what will they want from me, so that I am prepared. I don't want to sound like an idiot, another thing, I am 27 and I honestly have never been to the doctor and I know that is really bad but its like if I ever been sick or anything I nurse myself back to health,Any weightloss attempts have been made on my own nothing that was supervised. I weigh 289 and my BMI is 46.6 I believe. Do ya'll think just from your experiences and the hoops you had to jump thru that I will have a hard and long journey getting approved. I appreciate any help or advice given.                            Natalie

Natalie, If you are interested in gastric banding you can actually log on to the new J&J Realize Band web site, and call their toll free number which is 1-866-REALIZE I believe, and they will help you with finding out what your coverage is. Good luck! Trace W. Curry, M.D. Lap Band and Realize Band surgeon Cincinnati, Ohio http://www.TheBandDoctor.com 513.559.1222 / 877.442.BAND DISCLAIMER:  Any information contained within is meant to be general medical advice only.  Please consult your surgeon on your specific problem!

Natalie.... great name, same as mine.

Anthem BC/BS has a dedicated department for bariatrics/transplants.  I've pasted the number below.  Call them and ask if your plan has coverage for surgery for the treatment of obesity.  They'll confirm your policy coverage and if covered will send you an information packet that will walk you through their entire process for approval. 

It's very important that you contact them first because my Anthem BC/BS policy will only pay 80% if I go to an ANTHEM Center of Excellence.  There are only two doctors in the Cincinnati area that are designated as "in network" for bariatrics.  If I chose any other doctor they would only cover 50%.

Call the number, the staff is VERY helpful and I believe very pro-patient.

Anthem Centers of Medical Excellence-National Bariatric                                                    800-824-0581 option 2 extension 2 (Angel is her name)

I had great cooperation with my insuror just by calling them on the phone.  I explained that I was interested in getting wls and needed to know what was required before submitting for approval and exactly what types of procedures are covered. 

Most insurance company reps know that the average person doesn't "speak their language."  I've generally found them to be very helpful though.   One thing I will suggest is that you start working to gather documentation and proof of your prior attempts at weight loss.  Many insurers will require some proof that you have tried to lose weight on your own, but been unsuccessful.  Since you indicate that you've never been to the doctor, you will not have evidence of prior weight loss attempts or a weight history available through your doctor's office.  So if you've tried Weigh****chers, Jenny Craig, Nutrisystem, TOPS, or any similar program and have documentation of your efforts, that may be helpful.   Good luck on your journey -  Kellie

I have the same insurance as you and I had no problem.  It helps  if you have the diagnosis code and procedure code. (ask your doctor)  One thing I was told was that if my BMI was over 40 I did not have to jump through any hoops, I would just get approved.  Hopefully, yours will be the same.  My BMI was lower but I still didn't have any problems.