How long does a pre-approval with Anthem blue cross PPO take?
I was wondering from others who may have anthem blue cross PPO insurance how long their pre-approval took? Mine pre-approval was submitted last week but I am so anxious to hear something already, I feel like I can't wait! LoL...how long should i expect? Is there anything I can do to speed up the process??
I have Anthem BCBS PPO with Teamsters, I was preapproved right away, but then had a 6 month period of evalutaion, supervised weight loss and pre-op appointments with psychiatrist, cardiologist, pulmonary doctors, etc. as soon as 6 months was up, I was approved immediately and surgery right after.
Good Luck to you, and use the time to research and research the surgery and post op care. Know as much as you can going in! It helps sooo much in the hospital and afterwards too!
HW: 249/ CW: 130/ GW: 140
on 1/25/10 11:52 am
Best of luck to you!!!
Hi Christopher, I just completed all my pre-op requirements. I am considered a lightweight also at 226 lbs. I am 5'3" so the 226 DOES NOT look "lightweight" at all. I do have co-morbidities, but they are pre-diabetes, high cholestrol and high triglycerides. I do have a BMI of 40 so that should suffice. I had proof that I was on medically supervised Optifast and that I had auto-ship Nutrisystem for over 7 months. My surgeon is an instructor for Loma Linda Hospital and has also performed a ton of surgeries. His center is a CME (Center of Medical Excellence) center. Anyhow, having given you more detail than you needed or wanted, I was wondering if my co-morbidities or situation was anything similar to yours? I am anxiously awaiting approval and am just scared to death they will deny it. I have tried for over 7 years to get down below 220, but to no avail. I have hypo-thyroid so that doesn’t help. I too have Anthem Blue Cross PPO. Oh, also, what was your co-pay? Out of pocket? You don’t have to give details on here, ball park figure maybe? I’m worried about that too, no one has talked to me about co-pays, hospital fee, out of pocket….. Any insight would be so appreciated!! Alina
on 2/4/10 3:38 pm
My BMI was 44. I did have co-morbidities but since the surgeon's office handled all of the details, I do not know if it was necessary for the co-morbidities--I doubt it. I also had hypertension, sleep apnea, GERD...
As far as the cost of the procedure, it really depends on your particular plan, and if your surgeon is a Blue Cross PPO provider. My surgeon and hospital were Blue Cross COE, but my surgeon was not a Blue Cross provider. My surgeon required a $3,200 cashier's check deposit from me before surgery. Blue Cross paid him $7,550 for the surgery and his surgery fee was $8,200. His Surgical Fee Agreement clearly stated that any monies received over $8,200 would be refunded back to the patient. Now he is in breach of contract and I am suing him. In addition, his office billed for an endoscopy of $750 that he never performed. In fact, I was not even at his office the date he said he performed the endoscopy. He then charged me a co-pay of $217.50 for the endoscopy HE NEVER PERFORMED.
I didn't have to pay the hospital anything. It was covered completely by my insurance.
I wish you all the best and keep us posted!!!
GUESS WHAT??!! I got a call from Anthem Blue Cross late yesterday afternoon and I got my approval!!! I was surprised that they were calling and not my doctor's office, but who cares!
Yay!! I'm so excited!! I'm a little worried about surgery of course, it is a natural fear. I hope recovery doesn't take that long. How long was your recovery? I'm having RNY.
So sorry to hear about your surgeon. That can be reported to the AMA or ASMBS right? I would picket in front of his office! You live close to me, I'll help you with that. It's awful to have to go through a lawsuit just to get what's rightfully yours.
I'm so glad I came across this site, I am going to be tapping in on everyone's experience and I appreciate your support and information.
How long did your approval process take? They are telling me 15 business days. I did call to follow up and my surgeon's offce had not even sent in the paperwork!!! They were waiting for another test result they got a week before!!! Just curious to see how long it took for your surgery to get approved.
on 4/22/15 10:09 am
I am so disappointed. We have Anthem Blue Cross through my husband's work (Intel).
3 1/2 years ago (December 2011) I participated in a medical device implant study that was supposed to help me lose weight. Unfortunately I was part of the control group. The study was in the process of getting re-approved when they told us whether our device was real or a dud (1 year after the surgery), so the option to get the device replaced was delayed to the point where I left the study in November of 2013.
I decided to get a vertical sleeve gastrectomy and began meeting with the doctors and dietitians about that process.
Right in the middle of that, I discovered a lump in front of my ear that turned out to be a parotid mass that was cancerous. We had to put the sleeve plans on hold while I was assessed to make sure that there was no more cancer in my body.
Once we got that clearance, they began gathering all the rest of the data they thought they would need to send to the insurance. One of the hard parts for me was to get compliant with my cpap usage and be able to show that with the cpap data. Got that done a couple of weeks ago and they submitted the request for pre-approval. It was denied because "all of the data about psychological evaluations and weight loss efforts was 2 to 4 years old." Well, yeah. I've been working on it for that long. They said they would need me to re-do the psych eval, and come up with 6 months of records of my diet and exercise. Keeping records of this stuff is my nemesis, but had the bariatric surgery people told me that I was going to have to have 6 months of records for them to turn in to get approval, I would have made the effort. That was never something they asked me for.
I don't want to put this off for another six months! I've been waiting so long already--since November of 2013!
on 2/7/10 8:37 am
Congratulations!!! That is such great news! Yes, it is normal to be excited and a little nervous! Nervousness always seems to come with the approval because the approval makes it all very real. But, soon that will fade away and you'll just be excited. I had my lap-RNY on July 21st. Five days later (still with a gastric drain in me) my wife and I went to Sea World with our children (on a humid summer day). Did I feel great? No, but i did it! About five days later we went on vacation for a week to a cabin in the mountains. I managed alright. Was I experiencing pain? Not too much unless I did things like bend over to release the emergency brake in the car.
Keep us posted...