ANTHEM BLUE CROSS WEIGHT LOSS FULL
ANTHEM BLUE CROSS WEIGHT LOSS PROFESSIONAL

Therefore, you have the right to an appeal (and to other options for recourse) if Anthem Blue Cross denies your claim for coverage. The state of California requires all health insurance companies to maintain an internal appeals process. If you’ve received a denial from Anthem Blue Cross, you may be wondering what to do next. Some denials are legitimate, while others should be contested so you can receive the coverage you deserve. However, what happens when you receive a denial of coverage from Anthem Blue Cross? Similar to other insurance companies, Anthem may deny a health insurance claim for many different reasons. As an insurance company, Anthem Blue Cross accepts premiums from patients in return for healthcare coverage. It is a subsidiary of Anthem Inc., which offers coverage to one in 8 Americans across the country.

What to Do if Your Insurance Claim is DeniedĪnthem Blue Cross is one of the largest health insurance companies in California.

What to Do If Your Health Insurance Claim is Denied.

Importance of an Insurance Denial Lawyer.

Hiring a Health Insurance Denial Attorney.

COVID-19 Business Interuption Insurance Denial.

Health Insurance 101: What to Do After Your Claim is Denied.

Disability Claims for Professionals and Executives.

Experimental or Investigational Treatment Denials.

ANTHEM BLUE CROSS WEIGHT LOSS FULL

The full statement on Bariatric Surgery can be found here. BCBS of Texas’ Weight Loss Surgery Full Coverage Statement BCBS of Texas’ Contact InformationīCBSTX’s contact information is found on their website. You don’t have to but you may save money if you do choose an in-network surgeon and have the procedure at a Blue Distinction Center for Bariatric Surgery. Do I have to use an In-Network Bariatric Surgeon? Yes – Blue Cross Blue Shield has Blue Distinction Centers for Bariatric Surgery. Does BCBSTX Require Center of Excellence? The surgeon must show that the original gastric pouch dilated or the band slipped or eroded. But the patient must show proof that they have been compliant with the post-operative diet and exercise routines. Revisions are covered when the original procedure does not achieve long term weight loss goals. Only if the patient has been compliant with diet and exercise routines post-operatively and had a complication with the original procedure that caused it to fail will BCBSTX pay for a second procedure. Is a second weight loss surgery covered if lap band doesn’t work? Which procedures are not covered by BCBSTX? Yes, lap band fills are covered and its not necessary to request documentation for refill and maintenance procedures. Unsure which procedure is right for you? Take our test. Biliopancreatic bypass with duodenal switch – only in patients with a BMI over 50.Gastric banding (Lap Band and Realize Band).Patients with serious medical illnesses in whom caloric restriction could make the illness worse.Patients with portal hypertenstion causing high risk surgery.

Patients with mental handicaps that render them unable to understand the rules of eating and exercising post-operatively.

If any of the following apply, you will NOT be eligible for weight loss surgery.

ANTHEM BLUE CROSS WEIGHT LOSS PROFESSIONAL

Evaluation from a professional counselor, psychologist, or psychiatrist within 12 months prior to surgery.

Documentation attesting that you understand the post-operative regimen.You are at least 18 years of age and fully grown.Documentation from the requesting surgeon that:

Body Mass Index equal to or greater than 35 with at least two of the following comorbidities.Ģ.Body Mass Index equal to or greater than 40.Two criteria must be met in order to qualify for BCBSTX to cover your procedure. Blue Cross Blue Shield of Texas’ Criteria for Insurance Coverage Use the contact information at the bottom of this page to find out if your policy has a specific exclusion for weight loss surgery. However, some policies do specifically exclude weight loss surgery. Blue Cross Blue Shield of Texas (BCBSTX) covers weight loss surgery.

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