Husband starting new job w/new insurance - Anthem PPO

Hi, all. My primary insurer is Health Span Preferred and their plan is simply that the surgery must be medically necessary. All I have to do is submit a letter from a doc that states WLS is necessary, and they will cover it -- but only up to $10K. My husband is starting a new job, actually AT Anthem, and we will choose the PPO as my secondary insurance. I'm hoping someone has experience with this plan and can tell me, specifically, what I will be required to do prior to approval. I had a psych eval done a couple of years ago, as I applied for and was denied due to not having medically documented 6 consecutive months of weight loss attempts. I was getting started on that when I got pregnant w/baby #2. So... I'm excited because, from reviewing the information in the insurance section of this site, it looks as though Anthem PPO is great as far as WLS goes. I want this surgery done ASAP. Can anyone help me to ensure that I am on the right track for approval as soon as possible? Thanks in advance!

Sarah, If my memory serves me correctly (as I am having to recall Anthem as an employer and the plan they selected)-you will need to have a psych. eval (the one from a couple of years ago is too old). You will need a nutritional assesment-the one you receive from a dietitian at your surgeon's office is fine. You need aprox. 2 years of medical records. Of course, you will need a letter from the surgeon as well. That's about it! If you are interested in the Lap Band-you must have a BMI below 50. Obviously, the normal criteria applies for the rest....BMI of at least 35 w/ a severe co-morbidity, or a BMI over 40. Please note, there may have been changes to Anthem's plan that I am unaware of. Good luck to you and your husband at his new job! Tracy Burch Dr. Trace Curry's office 513-559-2545

Thanks a million, Tracy! I'm probably going to be calling your office within the next few weeks to get this ball rolling.

Sarah, It sounds like you work for Warren County. I also work for Warren County. I got approved last year thru Health Span and it only took me 3 days to find out that I was approved. I had been trying to get approved thru our previous insurance Medical Mutual and they kept denying me for over a year. Health Span is real easy to deal with. I had my surgery May 2005 and I am doing fine. Good luck.

Hi, Michelle. I do work for Warren Co. What a coincidence. If you don't mind, I'd be interested in talking to you about your experience, what surgeon you used, etc. Please email me if you'd be interested in discussing this. My email is [email protected] Thanks in advance!

Hey Michelle..do you work on the first floor of the administration building? blonde hair perhaps?? If so, I am the paralegal that stopped and chatted with you..just wanted to say HI!! Brenda

if you have anthem ppo blue access they will not cover the surgery no matter what. I would check into it. Pattie