Question:
Anyone have ANTHEM BC/BS Community Choice PPO?
Hi! I have Anthem and have read some people say they were approved after the first letter and some had huge battles with them. What were your experiences? Did they pay for everything? What about the out of pocket maximum? Did you get billed for it? Were they really strict on the requirments? I called the member relations line and they said I needed the psych consult and a dietician consolt and it had to be medically necessary. So,fingers crossed! Please post your experience with Anthem,if you wuld be so kind! Thanks,Stacy — Stacy C. (posted on May 2, 2002)
May 2, 2002
3 days ago my response would be VERY different...I had a horrible time
dealing with Anthem. They lost paperwork...didn't take my file to the
nurses, didn't communicate with each other at all...overall a really bad
experience...that is until Tuesday. They must have gotten tired of hearing
my voice 2, sometimes 3 times a day (everday) and they decided to stop
playing games, and what do you know--I got approved. My advice is to keep
on them...get copies of everything you or your doc's office faxes to
them...becuase they will loose it. And be persistant!! Let them know that
you plan on keeping in close contact with them, and that you are serious
about this surgery...I think all insurance companies try to weed out the
people who aren't serious about it at first! Good luck, and if you need
support (and you probably will), drop me an e-mail at [email protected].
I know the stunts they pull, and perhaps my experiences can help you!
— Sarah P.
May 2, 2002
Hi, Stacey. I was really worried about bc/bs also. I was approved after
about a week from them receiving my documents. I had my family dr. make a
detailed list of co-morbidies and he himself wrote a letter to my insurance
co. I have a long family history of co-morbidies. Make sure you list all of
your families also. I had to have proof of a dr. assisted weight lose
attempt and various other weight lose attempts(weight watchers, physicians
weight lose, jenny craig)List them all. If your B.M.I is above the amount
recommended for you then this is a big help in getting approved. I did not
have a phych eval. I was told by the nurse at Dr. Rashid's that BC/BS of
Ohio had been sued because they denied someone who would have died without
the surgery. The plantiff won and now they are more likely to o.k. the
surgery as long as all the papaerwork from the Dr.'s is in order. This
should not be a problem if you have a Dr. who is knowledgable.
— Jennifer F.
May 2, 2002
My experience with Anthem BC/BS is that they were a real stickler for
having 12 consecutive months of dr. monitored dieting. I had been on just
about every diet around, just not one with the Dr. because insurance won't
pay for dr. visits dealing with diet. Give them a chance, but if they start
saying you need 12 months dr. dieting, I would advise to contact Walter
Lindstrom at obesitylaw.com. He says that is an illegal requirement because
it is not generally accepted practise, and they can't legally require you
to do something that they clearly exclude for paying for to obtain surgery.
Good Luck.
— Dell H.
Click Here to Return