Insurance Questions

Does anyone else have Anthem BC/BS Blue Preferred Plus (POS)? My policy specifically excludes any weight loss surgery and the Insurance company stated that to even begin to fight, I need to have to start with my doctor (which I know--and I have) but I'm curious to see if anyone else has had problems getting this through the appeals process with Anthem. How long did it take? (I've read stories on here about approval being nearly instantaneous and others where its been jerked around for months) The CSR I spoke to was very friendly but unable to give me much advice, accept to say he thought it would be unlikely that I would get approved because of the specific exclusion... Any thoughts or opinions would be helpful I'm just at the beginning of this process and am still not sure how to proceed. Thanks! Sheila

Sheila, I'm not sure there is any magic answer to your question. Some people have been approved by their insurance first time around in 24 hours, some folks have gone through 3 appeals and finally after getting an attorney involved they have been approved. There's an attny named Gary Viscio who offers a pre-submission type package for folks who might get denied. I don't have the need to use him, as I was approved - but he's had WLS himself and seems to be someone that folks like. obesitylawyers.com just add the www to that. As much as we want those CSR's to give us valuable info, he doesn't really have a clue about the realy likelihood of you overriding the exclusion. I know this is not what you want to hear, but it's the truth. Trust me, I was an absolute information glutton, I just kept reading the UHC profiles in the hopes that they somehow secretly spoke the outcome of my request for surgery. Anne

Thanks for your kind words, Anne. I really appreciate them. My first step is going to be with my PCP. She kind of figures that, if it is what I want to do, well, fine...but I'm not feeling any support from her and I'm worried about what kind of letter she'll be writing to the Ins. co...that is, if I can get her to. I asked her for a letter on monday and got a script with my height weight, borderline BP and that exersize and diet had failed. Thats it. On a Perscription Note. I think it is going to be a long hard battle. I don't want to switch PCPs because she's a fantastic doctor, but I may have to look at my options. I'll find a way. I'm committed to making myself healthy and strong. I know I need help to do that (you can't imagine...well maybe you can...how difficult it was for me to get to the point where I can admit it and not cringe). Thanks again for your support. I hope everything is going well with you and that you have much continued success!!! Sheila

Please, please appeal! It's the only way to get these insurance companies to cover WLS, to be a huge pain in their but when they deny you. Dr. C The Deaconess Surgical Weight Loss Center Cincinnati, Ohio (513) 559-2545