Anthem BC/BS

Long story short, this is my second-try at having the surgery. I was denied in the Fall of 2004 with Blue Cross Blue Shield of North Carolina. I hired Gary to fight the denial and we won...but when we won, I was pregnant and couldn't have the surgery.  Almost two years later, I've asked the surgeon to re-open my file and we are trying again. I now have Anthem Blue Cross Blue Shield and their policy is rather ambiguous. Based on that ambiguity, I have met all their criteria -- although most of the records are older (aside from a recent letter from my PCP stating that yes, I am still fat!)   We (the surgeon's office and I) were also debating whether or not to mention to Anthem that I had been approved by another BC/BS affiliate two years ago -- not sure whether she ended up mentioning it in her letter or not, but Gary, I'd be curious to get your thoughts on whether or not that should be mentioned and whether or not the prior approval carries any weight (no pun intended!). Has anyone else tried to get approval with Anthem BC/BS? Was it as easy as their policy makes it seem? Or were their hidden hoops that I need to start preparing the documentation for...? Thanks! Angela

I have Anthem BCBS (national account).  I am actually preparing my documents today to try to get approved.  I go see my surgeon on 07/19/07 and I plan to have his office submit the documents ASAP after my consult.  If you submit before that, let me know how it goes.   I am hoping and praying that I don't have trouble and don't get denied.  I really don't think I have the nerves to fight it if I am, but I will probably try because I need this to save my life.   Good Luck to me and you! 

Anthem usually pays after a brief fight.  I think youll be ok.To be sure, get a copy of their written policy

Well, I guess I'm the first one to get approved since you  haven't replied yet. My clinical was submitted a week ago today.  I had to stay on them, but I was approved today - 7 days after submission. WOO HOO!!! Good Luck!

Congratulations! My stuff still hasn't been submitted. It was supposed to be done Thursday and the dr's office called to go thru my stuff one more time (since my case is a little unique) and we've played phone tag since then. I've been told that once I'm approved (positive thinking), my surgery will be within 2-3 weeks. Hopefully I'll get approved as easily as you did! Did you have a specific fax number you had them send the claim to?

I had the fax number for Teresa Emmons (the RN over my case). I have a national account - is that what you have?

How did you get her fax number?   Hmm..I don't know if it is a national account or not. The address for the PO box is Kentucky -- so maybe it is Anthem Blue/Cross Blue Shield of Kentucky?

My nurse's insurance card says:  Anthem National Accounts The fax number is 866-255-2471.  But my insurance address on all my correspondence with them, including her card, is Ohio.  As soon I called my insurance told them I wanted to pursue getting bariatric surgery, they sent her card to me with a packet of information on what they covered and what they didn't.  I have dealt directly with her and only her via email and calls since then.   I have never gotten anything that I recall from Kentucky, so your Anthem BCBS is probably different than my Anthem BCBS.  You probably don't have a National Account.  You know how many versions of BCBS there are out there, even Anthem BCBS.  But maybe yours will be as fast as mine.  I wish you best of luck! 

Could you send me the email address for the nurse you spoke to?

Good luck! My Anthem plan had an exclusion so I switched insurance co.