Anthem BC PPO

I was told that as of March 1st they no longer covered the surgery, but have seen information that others with the same insurance have had it covered. Anyone with info about this would be very helpful. Thanks! Amy

I was told the same thing. I called customer service on three different times, with 4-5 days in between each call. The first call, I got a trainee that was extremely flustered, she went to ask a supervisor, came back and stated it wasn't covered. On the last two calls, I supplied the specific procedure and diagnosis codes. I was told that it had to be medically necessary and meet certain requirements for precertification. Btw, the requirements are the same as the new Ohio Senate bill (SB41) that will mandate converage for all insurance companies. BMI > 40, multiple comorbidities, etc. To be honest, I don't know what to expect. I do know that coverage may be dependent on your specific employer's plan and when the contract with Anthem renews. My package is suppose to be sent to Anthem any day now, so I'm just anxiously awaiting the verdict. The good news is that those with Anthem that are getting approved, seem to be getting approvals within a week of application. Email me if you want more specifics. Call Anthem customer service and ask them if the procedure code CPT 43846 (Roux-en-Y Gastric bypass) is a covered benefit. There is also a diagnosis code of morbid obesity which is required, but I don't have that code handy at the moment.

I have Anthem BC/BS ppo and I had Open RNY in April. They did change the wording a bit but they still cover it from what I understand. They just left out the words (Morbidly Obese). They covered mine 80% . Just has to be medically nec. Jamie