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How long does a pre-approval with Anthem blue cross PPO take?

LatinaMom209
on 1/24/10 11:37 pm - Merced, CA
Hello all,

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??
~Truffles~
on 1/24/10 11:42 pm - VA
I was told about 15 days.

Calling to verify your info was received is a great way to get info.

I don't think you can speed up the process though.


Good Luck


"Lead me not into temptation; I can find the way myself."  ~Rita Mae Brown
trbsmom
on 1/25/10 4:46 am
RNY on 03/25/10 with
Hi,
I have BC/BS PPO too...and my paperwork was submitted last week also. Monday was a holiday...so they couldn't submit until Tuesday. I was told anywhere from 2 weeks to 6 weeks to hear something.
carol.grangel
on 2/6/10 6:20 pm - East Rochester, NY
Mine only took 2 weeks, three tops. I had my surgery Wednesday, 2-3, and am home and feeling pretty good!
dnctroia
on 1/25/10 4:49 am
Good Morning,

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!

Christine

Heather E.
on 1/25/10 5:58 am
DS on 02/23/10 with
I just had to fight with them for six months - took it to an IMR [independent medical review], and won.  It all depends on your starting weight and comorbidities.  I am a "lightweight" and they weren't accepting my comorbidities as being "severe enough" for surgery to be "medically necessary."  Best of luck to you.

~Heather~

HW: 249/ CW: 130/ GW: 140
 

artedd
on 1/25/10 9:18 am - Schaumburg, IL
Heather, I too am considered "lightweight". May I ask what comorbidities you had?
Heather E.
on 1/25/10 11:46 am
DS on 02/23/10 with
Pre-diabetes, hypertriglyceridemia, osteoarthritis, mild sleep apnea, and GERD.  None of these were good enough for them. 

~Heather~

HW: 249/ CW: 130/ GW: 140
 

artedd
on 1/25/10 11:48 am - Schaumburg, IL
Bummer. sounds like I am in for a fight. :(
artedd
on 1/25/10 11:51 am - Schaumburg, IL

Bummer. sounds like I am in for a fight. :(
(deactivated member)
on 1/25/10 11:54 am
Heather,

Were you fighting with Blue Cros for DS or RNY?
Heather E.
on 1/25/10 4:52 pm
DS on 02/23/10 with
I was fighting with them for the DS; however, it really shouldn't have made a difference.  Both procedures are equally covered under my policy, with the exact same requirements.

~Heather~

HW: 249/ CW: 130/ GW: 140
 

(deactivated member)
on 1/25/10 11:52 am
I have Anthem Blue Cross of CA PPO.  I did my pre-op tests and psych eval on July 1-2.  It took about one week for my office to submit the approval request.  One week after that I had approval and I had surgery on July 21st.  Mind you (I don't know about your surgeon) my surgeon does a tony of RNY surgeries (almost 6,000 RNY total), and his insurance biller is very familiar with the process.

Best of luck to you!!!

Chris
amrodriguez70
on 2/4/10 2:52 pm - Upland, CA
RNY on 04/05/10 with

 

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
(deactivated member)
on 2/4/10 3:38 pm
Hello Alina,

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!!!

Chris

amrodriguez70
on 2/6/10 6:12 pm - Upland, CA
RNY on 04/05/10 with
Hi Chris,

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.

Talk soon,
Alina
KathrynRose
on 8/14/13 10:54 am - CA

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.

Thanks!

Katy

 

(deactivated member)
on 2/7/10 8:37 am
Alina,

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...

Chris