Question:
Help Anthem BCBS DENIED

How do I appeal? How long does the appeal process take....what should I do??    — melindainfla (posted on October 4, 2003)

October 4, 2003
Anthem's appeal process is documented in great detail on their web site. I reviewed it while waiting to get approved. The talk about time frames and next steps. Fortunately, I didn't have to use that process.
   — rleffler

October 4, 2003
You need to find out why they denied you I would call for an explanation. You also need to know what your particular policy states in regards to surgery. Mine excluded weight control except for medically neccessary surgery. They denied it being medically neccessary because I didn't prove I had a 12-18 month supervised diet. I then appealled and provided notarized statements from a friend I went to weight watchers with and I had gone to a diet clinic 3 times over a year time frame. The dr had put in his records I was going to WW. If you haven't had ay supervised diet I would start going right away in case you lose. They then denied me (30 days later) again saying I haven't proved it was life threatening the Dr's nurse advised that I contact the Attorney Generals office since they changed the criteria. I called Anthem to find out why they changed to criteria and told them what the Dr's office said to do. They said they would review it to see if they reviewed the wrong policy. I was approved before the end of the day.
   — Candace F.

October 5, 2003
I would find out EXACTLY why they denied you. I was under the impression that Anthem was pretty good about approving people. It may not be them, but that your employer has chosen to exclude coverage for WLS. I was approved by Trigon (which became Anthem) for WLS within days and I was a revision. They also approved me for a TT, but I had to postpone it because I found out I am pregnant.
   — Ali M

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