The medical insurance I have now will be ending the end of December, so I am looking for new insurance. I am looking at Anthem, but I can't get a straight answer on whether they cover an autologous stem cell transplant for multiple myeloma patients.
My insurance agent talked to someone there and they said yes, but they could not give me how much they cover. I went online to Anthem and what I found there said they don't cover stem cell transplants.
Does anyone have Anthem insurance and could tell me if they had a stem cell transplant and was it covered? Or who I could contact to find out?
I am not having much luck finding out what I need to know.
Forums
4 posts
• Page 1 of 1
-
lacy sorenson - Name: lacy sorenson
- Who do you know with myeloma?: myself and my mother
- When were you/they diagnosed?: sept.23
- Age at diagnosis: 49
Re: Anthem coverage of stem cell transplants?
Lacy,
You need to do a few different things when pursuing this. First, you need to look at their published policies. Just google on "Anthem policy" with the additional qualifiers you want such as "myeloma transplant". You will then get:
https://www.anthem.com/medicalpolicies/policies/mp_pw_a045963.htm
Then you should request a detailed certificate of coverage for your specific policy you are considering (this is a 100+ page document) and search on transplants in the doc and see what that specific policy states wrt transplants. Depending on your state and if you are looking on an ACA marketplace website, you can often find this document in the bowels of the policy description.
Note that any insurance carrier has very different coverages for different procedures depending on the specific policy being considered (they have many). Therefore, asking somebody about their specific experience with Anthem wrt transplant coverage can be misleading.
Then, armed with this information and the specific policy you are considering, you can call Anthem about this specific policy and draw their attention to the documents you are viewing and try to get a straight answer.
Isn't this fun?
You need to do a few different things when pursuing this. First, you need to look at their published policies. Just google on "Anthem policy" with the additional qualifiers you want such as "myeloma transplant". You will then get:
https://www.anthem.com/medicalpolicies/policies/mp_pw_a045963.htm
Then you should request a detailed certificate of coverage for your specific policy you are considering (this is a 100+ page document) and search on transplants in the doc and see what that specific policy states wrt transplants. Depending on your state and if you are looking on an ACA marketplace website, you can often find this document in the bowels of the policy description.
Note that any insurance carrier has very different coverages for different procedures depending on the specific policy being considered (they have many). Therefore, asking somebody about their specific experience with Anthem wrt transplant coverage can be misleading.
Then, armed with this information and the specific policy you are considering, you can call Anthem about this specific policy and draw their attention to the documents you are viewing and try to get a straight answer.
Isn't this fun?
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Anthem coverage of stem cell transplants?
Hi Lacy,
I had Anthem group coverage, and it did cover my auto transplant. It did not cover travel, lodging, etc. but did cover all tests and associated medical bills. I think it varies from state to state. Once I reached my deductible and out of pocket, all medical bills were covered with no additional copays.
A couple of times, I've called the customer service number on my Anthem card to ask questions. There's generally a long wait to get through to a person, but once I did, I found the reps to be very helpful.
Best wishes on getting the info you need, and I wish you much success on your transplant.
I had Anthem group coverage, and it did cover my auto transplant. It did not cover travel, lodging, etc. but did cover all tests and associated medical bills. I think it varies from state to state. Once I reached my deductible and out of pocket, all medical bills were covered with no additional copays.
A couple of times, I've called the customer service number on my Anthem card to ask questions. There's generally a long wait to get through to a person, but once I did, I found the reps to be very helpful.
Best wishes on getting the info you need, and I wish you much success on your transplant.
Re: Anthem coverage of stem cell transplants?
You can also ask at the cancer center where you would have the transplant if they accept Anthem insurance for transplants.
Nancy in Phila
Nancy in Phila
-
NStewart - Name: Nancy Stewart
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 3/08
- Age at diagnosis: 60
4 posts
• Page 1 of 1
Return to Insurance & Patient Assistance Programs