BCBS of CA Anthem PPO

I have read on previous posts that some people have had approval issues with BCBS of CA Anthem.

My question is are those issues due to the employer's decison not to cover WLS through BCBS?

I called to check my coverage prior to scheduling my initial consult with a doctor and was told that WLS surgery was 100% covered.  Of course, there were BMI and clearance requirements associated.

I just dont want to be blindsided with a silly denial after paying a refundable fee for the surgeon to submit my paperwork to the ins company.

Hi. I just came across your post searching for some other things... I have Anthem BCBS PPO of CA and I was denied even after exhausting all of my appeals.. I only wanted the VSG surgery though and it's considered experimental so that's why.. They would've given me the other surgery (I think the one you want, the RNY).. That might be the case why people are not getting approved, but I heard rumors that the VSG is coming out of the experimental status and it'll have it's own CPT code (when that is, I don't know). Hope that answers your question!
Christy

Hi.I work for BCBS and here is the scoop: Your surgery must be 1) covered as a benefit by your employer and 2) meet medical policy guidelines: a BMI of 40 or more (or 35 if you have diabetes or heart disease), you will need the DR to document that you have a history of attempting to lose weight by diet and exercise, esp. within the 18 mos prior to surgery.You must also be deemed fit to withstand surgery and have a mini psych assesment that focuses on your understanding of what your responsabilities are after surgery and the center you go through has to offer info about diet and excercise and support resources available after surgery.Most people qualify with no problems.The ones that deny are usually not covered because their employer does not offer WLS as a benefit or they are trying to get a new procedure that is experimental. Good Luck and I hope this  helps!

Will ANthem Ca pay for VSG instead of the Gastric Bypass or Lapband if your doctor states you are not a good candidate for those? I am on 3 BP medications presently.