Anthem issues

sunseeker007
on 3/2/07 3:56 am
Hi: I was checking my coverage with Anthem.  In the main part of the policy, it does not forbid Roux en Y (or any other similar surgery).  However, it is listed in the exclusion.  For bariatric surgery, regardless of the purpose it is proposed or performed. This includes but is not limited to Roux-en-Y (RNY), Laparoscopic gastric bypass surgery or other gastric bypass surgery (surgical procedures that reduce stomach capacity and divert partially digested food from the duodenum to the jejunum, the section of the small intestine extending from the duodenum), or Gastroplasty, (surgical procedures that decrease the size of the stomach), or gastric banding procedures. Complications that result in an Inpatient stay or an extended Inpatient stay for the bariatric surgery are not covered. Has anyone had any success in appealing similar exclusions with Anthem (or another company)? Thanks,  L
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