Has anyone used Anthem Healthkeepers HMO for surgery?

Hi, all! I just called my insurance company and they said they do not cover bariatric surgery of any kind. I could swear I had read about other people who use them and some doctors that accept them. Am I asking the wrong question?

I'm 36 years old, my BMI is 39.9 and I have had high blood pressure for 3 years. I would think that this would be covered, especially in an HMO. HELP!

Repost from Main Board (sorry, I didn't know where to post.)

Tammy

Tammy,

I work for Anthem so I would be happy to help.  It is not about others having HMO it is about if the specific policy you have has coverage for weight loss surgery.  Each group (employer) must decide if they want to purchase the rider for WLS or not.  Most with HMO do not have this rider as it is very expensive to add onto a policy.  It also can not be purchased for just individual policies.  It must be for the entire grou*****t at all.  If you have enough comorbidities (not BMI) then there is a small chance that surgery could be covered based on medical necessity however it is not likely.  Call the number on the back of your card and ask specifically if WLS is covered or excluded from the policy.  That is the place to start.  Please message me if I can be of any help please message me privately since I rarely come on here anymore.  I just popped in at the right time to see this!

Tammy

Tammy  Great to see you !      How are you?

Thank you!  I miss everyone but need to stay out of the drama and away from certain people who frequent this board.  My sanity and my childrens privacy depend on it and I always put them first.  I am on facebook tammy clifton; [email protected]) if you want to look me up there.  Life has never been better.  Steve has been gone for months and I have never been happier.  I am coming up on 5 years post op, have maintained my weightloss perfectly and even had a baby then lost all that baby weight plus some.  It is just proof for me that the tool we are given WILL work if WE chose to use it properly.  This is of course being said barring any complications like ulcers, feeding tubes, etc.  I am well into my journey for plastics and will have a date soon.  My "angel" has prepaid for me to have a LBL, brachioplasty and breast lift with augmentation if I want it but I have not decided if I will be having that or not.  All I am waiting on now is being able to have surgery.  I can't do it while nursing Claire.  I do greatly miss the board and most everyone on it.  I am always available by PM or phone or email if anyone wants to chat.  I know I love the communications I already have with some on the board!

How have YOU been? 

Tammy   doing well.      We all understand.  But know that your kindness and wonderful advise was an inspiration to me and many  oerthers         I am trying to payback it forward.  I hope  can help others as you did for me.  

As to the PS   OMG I am so glad I did not wait.    My lower back and hip pain has subsided.   Everyone makes comments on wow you look incredible.  I kind of still see a kind of Steve Urkle in high water pants.    16 lbs of flesh and scar tissue taken from my gut.   One thing for sure you will recover so better without the lipo.     

When you are ready do it just for you and feeling better. 

I am here too if you need to talk.  

Tam is right. I had Anthem BCBS HealthKeepers ****il October of this year, when they wanted to double rates, and now I have to have Kaiser....). I asked every way I could think to ask if they covered the surgery, and no, your company has to have a rider. I ended up being self-pay.

Well worth the money, though!

Best of luck.

Julie

Thanks for the responses!

Julie, I had no idea qualifying for surgery would be so difficult. Believe me, if I had the means, I would pay for it. Congratulations on your weight loss!

Tammy (great name!), After reading your response, I called my insurance company back. It would cost an extra $142/month to add the rider. And with no guarantee that I would be approved, it’s not worth it. For a family of 6, we already pay a little over $900 per month. I can’t see paying more.

Tammy T