Empire Blue Cross Blue Shield PPO (NJ)

[jay150 5]

Hi...I was just wondering if anyone has any insight on the procedure and time frame for Empire BCBS in NJ. Thanks.

[happygirl65 5]

Well, I don't know if NJ is the same as AZ but BCBS seems to have a LOT of information on their website...to be honest I found the simplest approach was to call the 800 number on teh back of my card...I exhausted myself searching every nook and cranny of the net to find a simple phone call was all I needed to know EXACTLY what was covered under my plan. :rolleyes2: They will also mail you a copy if you request it of the specific requirements.

BUT my plan required :

BMI of 40 or 35 with co-morbidities

diagnosis of morbid obesity for 5 years

Clinical documentation of diet attempts to lose weight in the last 2 years including self directed dieting, commercial programs, nutritional counseling or exercise programs

Clinical documentation of for an active plan for active participation in pre-operative instruction program and post operative or follow up care plan in cluding preoperative nutritional counseling and must show ther is a plan in place for post-operative nutritional counseling as well

pre-operative clinical assessment and documentation must reflect a significant motivation and understanding of the risks associated with intended surgery as well as understanding of the lifelong restricted eating habits that will follow

Must be 18 yrs or older

Individual has no treatable condition that may be responsible for the morbid obesity like endocrine or metobolic etc

Individual has no significant liver, kidney or gastrointestinal disease

Individual has no drug or alcohol abuse - must be abstinent for 12 months or more if there is a history of drug or alcohol abuse

Individual has been evaluated by a licensed psychologist or psychiatrist documenting the absence of psychopathology the may limit the individuals ability to understand the procedure

I would expect other states to pretty much be the same but you never know...also they have an access fee of $1000 which is out of pocket on top of your deductible,,,but your mileage may vary and you should call your company to find out...also SOME employers can specifically exclude bariatric surgery from their health plan so you will want to check on that as well.

Good luck to you!!!

Edited November 11, 2010 by happygirl65

[jay150 5]

Thanks so much for all of the info!!!

[lawismylife 41]

I have that insurance. You need 3 things to get clearance:

1) Psych letter

2) Nutritionist letter

3) Letter from primary physician "recommending" you get the band.

Once I had all these things, it took less than 2 weeks to get clearance. Maybe even a week.

Good luck!

[Kathryngnv 0]

I have Horizon Direct Blue Cross/Blue Shield of NJ and it took a very short time for the okay. I think the paperwork went in late October and I had my surgery on 11/4. Good luck!

[jay150 5]

Thanks so much! Hoping my insurance approval is just as fast!