Anthem!

I have Anthem blue access ppo, how can i find out if there are any changes in the new year, i cant even find out how to find anything on there site for WLS. Thanks

I have Anthem Blue Cross Blue Shield PPO and I am having the same problem. I am listed as "pending" upon the nurse's review. I was told yesterday that I have a calendar year upon approval to get my services that have been approved. I was worried that an exclusion would be implemented 1-01-07.  The only changes that have been announced is an increased in deductibles and a 2% increase in premiums.  I say on here the other day from a post that you can ask for a plan summary for 2007. I am thinking about doing that. My husband would have to do it since he has the insurance through his employer. Hope this helps...... Vanessa

The problem is mine does have a exclusion! iam trying to find out if its going to change to the better for the new year.so i can get started on my journey, I wish you the best of luck on yours, I have medical problems but the inc guy said if i were a dibetic it would be covered, doesnt make sense,but iam glad iam not, my mother and a few in the family had it, but if i dont get somewhere theres a chance one day i could, All Anthem b/c are different in each state iam learning, well long enough. you take care and best wishes.

Like most big insurance companies if you go on anthems website and choose the state your insurance is out of (not always the same as where you live or where you work so be careful with that) you can go in as a provider and read there med policies you can even print them out and take them to your next dr's apnt it can be helpful as far as any changes usually if there are any big changes in a companies coverage they will let you know before they take place so if you havent heard anything from your employer or anthem chances are nothing is changing but to be sure you can call anthem and they should be able to tell you if there are any major changes happening... I wouldnt worry too much about it if its covered and next year it wont be chances ar you would have heard something as far as exclusions i would apply and see what happens and apeal right away when they look at an apeal it is a team of drs and nurses that usually for most insurance companies dont even look at your policy only your health records or information that you have provided so dont give up to easily just show them your not going anywhere... if you need help finding the med policies just send me a message and i will help you get the link... well goodluck!

Thank you so much for the information, iam not going to give up but iam waiting till first of the year to get my one on one with the sergeon, ther office did tell me they would send in all my paper work and if it were denied they would appeal it, so iam going to do that. I have went to the Anthem web site went to every link and couldnt find anything on WLS maybe iam not doing something right. Thanks a bunch!

Here is the link for the policy on "Surgery for Morbid Obesity." http://www.anthem.com/medicalpolicies/noapplication/f4/s10/t 2/pw_034084.pdf However, since your employer has an exclusion of WLS on your particular policy this is not really going to count for you.  It really doesn't matter about Anthem, since it is your employer who has chosen to exclude WLS from your policy.  Unless your company decides to include WLS on their policy, there is nothing that Anthem can do.  As you can see by their policy, Anthem does cover the surgery, but only for employers that elect to include this type of surgery on their policies.  I'm not aware of too many people who have gotten around an employer exclusion without the help of an attorney.  You might want to consider that or if you have any other choice of insurance (like through a spouse or if you can change insurances altogether) you could try that.  Sorry to be so negative, but I'd had to see you waste a lot of time trying to get around an impossible border. Good luck with everything.

The thing is if it all has to do with the employer excluding it, how come when i spoke to one of the reps they more or less said they cover it if i was a dibetic, Thats what i was told from Anthem so i wonder why they dont count other  med problems such as Gerd, Ademia, HB, high Cholestrol,etc.. Thanks  for the info i will look into it .

because i dont have your exact policy in front of me i cant say exactly but it sounds like maybe it is covered if they said it is covered under certain criteria then its not excluded and based on med nec you may be able to get around that which is what i thought the first time i read your post i would get a copy of your certificate of coverage and look through it there not as scary as most people think

Thanks to all who have posted here. I have learned so much for each post. The link for medical policy was very helpful for me. Thank you so much. Gee, I love Obesity Help!! Vanessa

I have Anthem insurance with bariatric surgery as an exclusion.  I've just recently crossed the border into diabetic zone.  From the posts here, it sounds like I am now eligible for bariatric surgery.  Does anyone know if all the prerequisites are still required? I know this sounds like an unhealthy thought path -- but I'm concerned that if I improve my health at this point, I will lose my 'diabetic' status as well as my eligibility for surgery.