New Anthem Insurance, I need help please!!

Hello everyone.  We are finally getting insurance thru my husband's job.  It is going to be Anthem HealthKeepers and we have to choose between the HMO and the PPO.   Both plans have this section of course:  This list of services and supplies is excluded from coverage and will not be covered in any case.  Your Anthem Healthkeepers coverage does not include benefits for:  Obesity: Care of obesity or services related to weight loss or dietary control, including complications that directly result from such surgeries and/or procedures.  This includes weight reduction therapies/activities, even if there is a related medical problem.  Notwithstanding provisions of other exclusions involving cosmetic surgery to the contrary, services rendered to improve appearance (such as abdominoplasties, panniculectomies, and lipectomies), are not covered services even though the services may be required to correct deformity after a previous therapeutic process involving gastric bypass surgery. Does this all mean the surgery itself isn't covered as well?  I am so desperate..   we have waited for insurance for so long and I just kept hoping that maybe it would be covered. Please give me any advice.  I need help so bad!!  Thank  you from the bottom of my heart!! Jennifer

I would call them and ask them point blank if they cover it or not and if they do, what requirements you have to meet.  You can also go on their web site.  I have Anthem of CO and they cover it but have a lifetime cap of $7500.

Jennifer, Anthem itself covers the surgery, however, your husband's company has to elect weight loss surgery as part of its covered benefit package.  I don't want you to give up hope but it sounds like your husband's company didn't elect weight loss surgery to be a covered benefit.  I know it sucks and I'm in the same boat you are in.  I got so frustrated because I *need* this surgery but there's not much you can do.  I would suggest that you contact the HR department and see if they have the option for you to purchase a "rider" so that weight loss surgery can be covered.  I hope you have better luck than I did because I too was told there was no rider option available.   You could possibly do what I've done which is get a different job.  I've done a little research and you can pretty much bank on federal, state, city or county jobs as to have the best insurance plans for weight loss surgery.  I start a county job on February 1st and I'm crossing my fingers and toes to see weight loss surgery covered when I enroll for benefits. Please don't give up hope.  If you need a friend to talk to etc... please send me a message.   Take Care, Leslie

Your best bet is to sign up on BCBS web site and get a copy of the exact policy regarding WLS.  If you go to the provider section, you should find a area where you can search for medical policies.  Be sure that you use "morbid obesity" as a search term.  None of them cover services for "obesity" such as weight loss programs and such, but will cover surgery for morbid obesity if found to be medically necessary.  Do your best to make sure that you know all the requirements needed to qualify for surgery.  It doesn't really help to call them and ask, as you will usually get several different answers every time you call.  If you cannot get the policy online, call them and ask for a hard copy of the policy.  It will save you some heartache in the long run.