Anthem Blue Access PPO and revisions?
When I had my rny 3.5 yrs ago I had Great West. 2 yrs ago my husbands company switched to Anthem Blue Access PPO and since I've been researching having my rny revised to a DS with Dr Husted, I called Anthem to see what their criteria might be. They "say" that they are pretty easy to deal with but u never know with these insurance co's. Anyone know anything about Anthem and their revision coverage? They said something about a $200k lifetime limit for weight loss surgerys.
Thanks for any tips!
Thanks for any tips!
Angela here is the Anthem policy for revisions:
Surgical repair following gastric bypass and gastric restrictive procedures is considered medically necessary when there is documentation of a surgical complication related to the original surgery, such as a fistula, obstruction, erosion, disruption/leakage of a suture/staple line, band hermiation, or pouch enlargement due to vomiting.
Not Medically Necessary:
Stretching of a stomach pouch formed by a previous gastric bypass/restrictive surgery, due to the patient overeating, does not constitute a surgical complication and the revision of this condition is considered not medically necessary.