Anthem Blue Cross PPO, Wisconsin

I've been looking at weight loss surgery for years and now my journey is begtinning.  I wonder if anyone here has Anthem Blue Cross Wisconsin PPO.  I called them today and they say weight loss surgery is covered.  They gave me requirements of BMI >40, only have to be currently enrolled in a weight loss program, and do psych and nutritional eval.  I am 5' 3", 246 lbs and have a BMI of 43, moderate to severe sleep apnea requiring c-pap, barrets esophagus due to GERD (no dysplasia), and have been going to a medically supervised weight loss since May.  

How has the approval process been? Are there more hoops to jump through than this?  I am going to the informational session on 9/28 and plan to get the ball rolling.  I am happy, nervous, and scared all at once.  

Also, if my out of pocket maximum is 1500 dollars with insurance, does this really mean I will only pay 1500 outside of my medical weight loss supervised diet which is currently 200/month!!

Let me know.  I'm anxiety ridden!!!

I just had my surgery on Aug. 8th. I had Highmark BCBS PPO but the billing was done through Anthem Blue Cross. Our company was out of Pennsylvania but we live in Wisconsin. I had to go through the 6 month diet and exercise program which was billed through major medical and applied to my deductible. The monthly doctor visits were paid by a $25 monthly co pay. The surgery and the rest were paid at 80%. I am going to be faced with about $2500 out of pocket when everything is done. I haven't received billing for everything yet.

After I completed all the requirements for my insurance it took approximately 2 weeks for the approval and another 2 weeks to schedule the surgery (depending on your doctors schedule). Not too bad after you satisfy your insurance.

It is natural to be feeling they way you are. I was so anxious for the surgery and then when the time was counting down, I was really scared at the same time. But then I focused on the main objective and that was losing weight and getting healthy. I was scared until the last minute but I don't regret it one bit now. Recovery is fast and weight loss is immanent.
 
It isn't easy changing your habits but you will feel it when you eat something you shouldn't. For a while it is just hard to figure out what you can eat because nothing feels or tastes good. Everything smells good. That is the point where I am at right now.  Good luck with your new journey!

 Thanks for the input, I appreciate it.  It seems overwhelming.  So you didn't have a "maximum out of pocket" clause in your insurance?  That stinks.  

I am glad to hear your surgery went well and you are feeling better.  I worry about the drastic change in my diet.  I truly will miss with all my heart diet coke and pizza, my two only weaknesses and of course neither is allowed afterwards, but I will adjust because I want to.  Will let you know what happens.

Please keep me updated on how you are doing.  It sounds like it's going very well!!!

Funny you mentioned pizza. I have been craving that since before surgery! I wasn't even a big pizza fan when I could have it! The good news is that pizza will be in your future. It may be a while before you can tolerate it but it will be there (in moderation of course). You may have to sacrifice the diet coke though. That isn't good on the new stomach. I promise you, if you do try to cheat on anything that isn't recommended, you will know it. Your new stomach tells you immediately. I ate the meat only from a piece of fried chicken the other day because I didn't have a healthy choice in the situation I was in. Before we left the resturant I visited the bathroom 4 times. Believe me I will never look at anything fried again!

You will adjust to what you can and can't have. It doesn't feel like a sacrifice. The only thing with me is that things smell really good. Then when I sit down to eat I get full so fast. That is the wonderful thing about this. I keep waking up with thoughts of failing my diet again and then coming to the realization that the surgery is done and I am still losing weight.

Keep me posted on your thoughts. Good luck with whatever you decide.