Anthem BCBS Exclusion

 Just when I thought I had it all together.  I went to my 2ND WLS seminar, signed up for all the hoopla, learned that Anthem BCBS was supposedly one of the easiest to get approvals from and then wham...The Dr.'s office called me and said there was an exclusion for ANYthing to do with weight loss.  I called the insurance members number and they suggested I call my HR/benefits department.  They flat out said there was nothing they would/could do about the exclusion.  My question is this...Do I have a snowballs chance in h*ll? I know for certain that if I don't have this surgery I am a ticking time bomb.  My sister is flying through the process and when she went for her nutritional eval they told her to encourage me to appeal but I honestly don't know where to begin since I don't even have a denial letter.  I have sleep apnea and am using 02 as well with my cpap.  I have GERDS, Horrible edema in both lower extremities, SOB, I can't walk even half deep into walmart without being in tears with my back, hips and ankles.  On the up side My BP is great, blood sugar is just slightly elevated (100-109 range) Cholesterol is pretty good aside from the good (and it was a bit low) It is getting to the point that I am having more and more trouble with breathing, walking etc and now I am experiencing heaviness in my chest.  I am very frightened that this is going to kill me.  Can I get any words of advice/wisdom/prayers...I could really use them right now.  Thanks so much...

My employer excluded WLS and my husband found a new job where there is coverage.  I know exactly how you are feeling.  Are you able to self pay???  There are a lot of posts about surgeons in Mexico that charge a fraction of what they charge in the states.  Keep researching and you will find a way.

Don't give up on yourself!

Good luck!

 Not at this time - I can't give up.  My doctor is sending me to a cardiologist for tests.  Somethings gotta give I just hope it's not me!

I am currently fighting a denial for a pre service review.  I have BCBS FEP in Virginia.  I was approved for WLS just not the Sleeve like I want.  Which surgery are you trying to get?  I would suggest posting all of your info on whatever surgery board it is your trying to get when you recieve your denial letter.  Chances are, just like me, someone in there has already been in your shoes and can give you some great info and resources.  Good luck!

 
If your employer specifically excludes WLS coverage your option is to find new insurance or self pay.  This is not an Anthem BCBS problem, but rather your employer.  Sadly, you're pretty much screwed.  I don't think there is any type of appeal that can get the insurance company to exclude a specifically excluded item.