Question:
Anyone have ANTHEM BC/BS Community Choice PPO?

Hi! I have Anthem and have read some people say they were approved after the first letter and some had huge battles with them. What were your experiences? Did they pay for everything? What about the out of pocket maximum? Did you get billed for it? Were they really strict on the requirments? I called the member relations line and they said I needed the psych consult and a dietician consolt and it had to be medically necessary. So,fingers crossed! Please post your experience with Anthem,if you wuld be so kind! Thanks,Stacy    — Stacy C. (posted on May 2, 2002)

May 2, 2002
3 days ago my response would be VERY different...I had a horrible time dealing with Anthem. They lost paperwork...didn't take my file to the nurses, didn't communicate with each other at all...overall a really bad experience...that is until Tuesday. They must have gotten tired of hearing my voice 2, sometimes 3 times a day (everday) and they decided to stop playing games, and what do you know--I got approved. My advice is to keep on them...get copies of everything you or your doc's office faxes to them...becuase they will loose it. And be persistant!! Let them know that you plan on keeping in close contact with them, and that you are serious about this surgery...I think all insurance companies try to weed out the people who aren't serious about it at first! Good luck, and if you need support (and you probably will), drop me an e-mail at [email protected]. I know the stunts they pull, and perhaps my experiences can help you!
   — Sarah P.

May 2, 2002
Hi, Stacey. I was really worried about bc/bs also. I was approved after about a week from them receiving my documents. I had my family dr. make a detailed list of co-morbidies and he himself wrote a letter to my insurance co. I have a long family history of co-morbidies. Make sure you list all of your families also. I had to have proof of a dr. assisted weight lose attempt and various other weight lose attempts(weight watchers, physicians weight lose, jenny craig)List them all. If your B.M.I is above the amount recommended for you then this is a big help in getting approved. I did not have a phych eval. I was told by the nurse at Dr. Rashid's that BC/BS of Ohio had been sued because they denied someone who would have died without the surgery. The plantiff won and now they are more likely to o.k. the surgery as long as all the papaerwork from the Dr.'s is in order. This should not be a problem if you have a Dr. who is knowledgable.
   — Jennifer F.

May 2, 2002
My experience with Anthem BC/BS is that they were a real stickler for having 12 consecutive months of dr. monitored dieting. I had been on just about every diet around, just not one with the Dr. because insurance won't pay for dr. visits dealing with diet. Give them a chance, but if they start saying you need 12 months dr. dieting, I would advise to contact Walter Lindstrom at obesitylaw.com. He says that is an illegal requirement because it is not generally accepted practise, and they can't legally require you to do something that they clearly exclude for paying for to obtain surgery. Good Luck.
   — Dell H.