Question:
Fighting CareFirst BC/BC Denial 11/1/02. Can obtain Anthem BC/BS in July.

I've been fighting a denial since last January with my husband's insurance. He works for a company based in DC, insurance based in MD, he physically works and we live in VA. It is extremely complicated. I am a Virginia State Employee and can obtain Anthem BC/BS during open season this April. I believe State Employees have a mandate that makes ins cover WLS but cannot check it out till we get our new books. My concern is pre-existing conditions and having both the insurances. Any opinions or knowledge on the subject, please share. Thanks. allison    — j A. (posted on March 28, 2003)

March 28, 2003
I have Anthem BCBS for Indiana state employees and they covered it. I did have to appeal a denial first. They want a documented supervised diet history of 12-18 months. In Indiana there is no such thing as pre-existing conditions because of the large base. I think the laws may have changed anyway as long as your insurance doesn't lapse. I would give it a try doesn't your bookkeeper or HR office have a copy you can look at? Mine policy excludes all weight loss except surgical and then only if medically necessary 40 BMI and supervised history.
   — Candace F.

March 28, 2003
I have Anthem BC/BS, but it's in Colorado, so what you can get may be different. Mine was covered, but you had to be at least 100 pounds overweight (or twice ideal weight), have 5 years (I think that was it) of medically supervised weight loss attempts, and have some co-morbids. Since I have Type 1 diabetes, I see my endocrinologist, who is also my PCP, at least 4 times a year. I am always weighed and, of course, she has often talked to me about losing weight, so I didn't have any trouble getting approval.<p>As for pre-existing conditions, there is a federal law (HIPPA) that says the insurance cannot use any pre-existing conditions clauses against you if you have had other health insurance in the 63 days prior to your getting a new policy, so that shouldn't be an issue. I think this only applies for organizations with more than 50 enmployees, so it would apply for you. You might try calling Anthem BC/BS customer service line and asking if they cover it.
   — garw