Anthem (BC/BS) insurance in Texas?

I just got a new job - new insurance - Anthem Blue Cross / Blue Shield. Their website seems to show Gastric Bypass is covered in Morbid Obesity only (cool with me) but the insurance rep at our open enrollment meeting said "no way - NO insurance companies cover it, only self-insured companies, and even that's rare." This company only just switched to Anthem for the 2008 year and so they don't have a detailed coverage policy to provide to us until it's "approved." Wondering who else in Texas has Anthem and if I have any hope?

Are you sure she said BECAUSE it is self-funded it isn't covered? Most plans DO cover them, it's the self-funded ones that write in exclusions, because they get so design the plan themselves. Companies that don't self-fund, just pick a plan that the insurance company offers. So if your job isn't self-funded it is likely to cover it because the corp website listed it as covered. But if it is self-funded, they can put in a rider to exclude WLS, but don't give up hope. You have some legal rights with plans with exclusions-- just hunt around this insurance board. I think it's funny that she said NO insurance company covers it!! The only time I ever heard of an insurance comp NOT covering it in general, is with plans where the employer decides to have it excluded specifically. This person doesn't know what they're talking about. Thousands are performed around the world daily, and not everyone is wealthy enough to self-pay. She needs to get the facts straight. If she was an Anthem rep, she was probably just trying to make you feel like " don't feel bad, no one gets covered for it any more"  so you won't look any further. I would have asked why does it list it as covered on Anthems website which manages many different types of plans? Good luck, and let us know what you find out about being self-funded or not, etc. Kahlua

Sorry if I worded that confusingly - this is a company with a 51+ employees plan, NOT self-funded. The rep basically said ONLY self-funded plans have the option to include WLS, so all of their other plans by default exclude it. I just read their website to say otherwise. This is Anthem out of Ohio - I'm in Texas. Was wondering what other people's experiences with this company were.

No, you worded it correctly. It's the rep who is incorrect. For over 51 employees and NOT self funded, most insurances DO have WLS as a covered procedure. So the company's plans comes with it already (as the web site states), but the self-funded plans have the option to EXCLUDE it. And by default, the other plans keep it! She has is reversed--that's all. I'd speak to someone else in benefits, or ask to speak to that ladies supervisor. Either she just reversed it in her mind and is getting it backwards, or she's trying to disuade you. Unless the standard insurance plans have changed for this upcoming year to exclude them in general, and only self-funded can add them. But I doubt that very much. For years--and even in the 2007 policies of all these WLS pts on OH and around the country-- their plans included it, and it was those with self-funded plans tht may have had exclusions.  I would assume it covers it, and start preparing now anyway. Start a medically monitired diet and see your doc EVERY month. I'm not sure if Anthem required 6 or 12 months on this diet, but each month has to be documented and tell your doc what they are looking for. This would include nutritional advice, exercise advice, advice of changing your behaviors, and may even require a food diary. You should have the new policy details soon and you will know for sure. I can't hurt to start meeting the requirements either way. Good luck, and when you see the policy with it have WLS as a covered procedure, I hope you shove it in that lady's face and tell her to learn her stuff and not give out false information. Kahlua

Oh I hope you are right. I have already put out feelers to the local doctor (whom I started, then stopped, the preliminaries when my last plan with UHC had an exclusion). I can't do a darn thing until Feb 1st (because I was hired Dec 5th - and it starts the first day of the month after 30 days ). But I should know if it is covered hopefully no later than the first week in January, and I'd be willing to pay for any office visits at discounted cash price until the insurance kicks in... *prays*