Approval by Empire Blue Cross Blue Shield

[Russian_BANDit_inNY 4]

Hi fellows Empire Bc Bs Banders :-)

Were you required for six month of diet tracking?

I called my insurance, they mentioned nothing, I read through all 25 pages of medical mambo jumbo - NADA. I called againe and ask - they said it is up to my surgeon.

PLEASE let me know if those of you who have Empire BcBs and were required by insurance to go through medically supervised six month diet program.

Thx

[honk 780]

Empire did not require me to do a specific diet but my surgeon required a loss of % of body weight. So my doctor wanted 10% loss which meant 30-34 pounds. By the time I had done all my surgery requirements: tests; group therapy sessions; appointments with nurses, nutritionist, surgeon it had been 3 months. So the question is what other requirements your doctor has and how much weight they want you to loose. My surgery had to be postponed for other reasons but I had finished the requirements including weight loss in 3 months.

[allygator 1]

Hi fellows Empire Bc Bs Banders :-)

Were you required for six month of diet tracking?

I called my insurance, they mentioned nothing, I read through all 25 pages of medical mambo jumbo - NADA. I called againe and ask - they said it is up to my surgeon.

PLEASE let me know if those of you who have Empire BcBs and were required by insurance to go through medically supervised six month diet program.

Thx

[/quote

I have empire bcbs as well and have JUST started the process. Other posts I have seen looks like they are pretty fair about approving. I have dieted for 18 years..if that idnt enought I don't know what is!!! Anxious to get started hope it goes quickly for BOTH of us!!!]

[EliyshevaLovesYahweh 6]

Hi fellows Empire Bc Bs Banders :-)

Were you required for six month of diet tracking?

I called my insurance, they mentioned nothing, I read through all 25 pages of medical mambo jumbo - NADA. I called againe and ask - they said it is up to my surgeon.

PLEASE let me know if those of you who have Empire BcBs and were required by insurance to go through medically supervised six month diet program.

Thx

Hi nako99. I was doing a 6 month supervised diet which is required by GHI (PPO) and I had three more weigh-ins in order to comply with GHI's prerequisite for Lap-banding. However, my husband's employer changed from GHI to Empire BCBS and on Dec 31st, 2010 RD we received our new insurance cards with Empire Bluecross Blueshield (which is when I found out of the change). I immediately called the surgeon's office to find out if my new insurance was accepted and if a six mo supervised visit was required by the insurer. The rep at the office told me that Empire Bluecross Blueshield is accepted if in-network and no six mo supervised visit is necessary. I really don't know how well informed this office rep is though. Nevertheless, below are some helpful websites which I found that could possibly answer your questions.

BCBS Medical Policies: http://www.empireblue.com/medicalpolicies/policies/mp_pw_a053317.htm

BCBS Blue Distiinction Centers for Bariatric Surgery: http://www.bcbs.com/innovations/bluedistinction/blue-distinction-bariatric/

BCBS - Directory of Providers: http://www.bcbs.com/innovations/bluedistinction/blue-distinction-bariatric/bariatricmidlevelcriteria.pdf

BCBS - Centers Hospitals (participating) for Bariatric Surgery http://www.bcbs.com/innovations/bluedistinction/blue-distinction-bariatric/bluedistinctionbariatric.pdf

Hope this helps.

----------------------------------------------------------------------------------------------------------

"Just when I figured out all the answers they changed the questions"

[honk 780]

LapBandForMe, keeping in mind each employer writes their own insurance policies. My experience with Empire BC/BS was really good for LapBand Surgery. I had reached my out of pocket maximum for in network for the year so I ended up paying like $250 for the sugery with an overnight stay in the hospital.

[Manda87 3]

I was approved quickly with no diet required. It was a very smooth process.

[Phranp 46]

Hi fellows Empire Bc Bs Banders :-)

Were you required for six month of diet tracking?

I called my insurance, they mentioned nothing, I read through all 25 pages of medical mambo jumbo - NADA. I called againe and ask - they said it is up to my surgeon.

PLEASE let me know if those of you who have Empire BcBs and were required by insurance to go through medically supervised six month diet program.

Thx

I have Empire BCBS. I live in So. California. And yes, I was required to have six months of diet tracking. I read it on the BCBS website. So, since I had been seeing and obesity therapist for almost six months before I started the process, we used my food diaries as the six month tracking. Worked out fine.

All the best to you.

~Fran

[EliyshevaLovesYahweh 6]

LapBandForMe, keeping in mind each employer writes their own insurance policies. My experience with Empire BC/BS was really good for LapBand Surgery. I had reached my out of pocket maximum for in network for the year so I ended up paying like $250 for the sugery with an overnight stay in the hospital.

Hi everyone! Yes Honk, I certainly agree. My husband is a retired foreman with the NYCTA of New York and our plan is Direct Pos with Empire Bluecross Blueshield. I have learned that although many may have the same medical insurance not all plans are the same. There is no better way to find out about one's medical plan than to call the insurer oneself.

I suggest for people in question re their medical coverage with WLS: call your medical insurer 800 # (# on the back of medical card) and ask directly re what the type of plan is and coverage. If you are unsatisfied with one representative's detailed explanation of your plan, dial the number again and speak to someone else.

In lieu of my uncertainties and due to my lack of courage - I took the initiative and called Empire Bluecross Blueshield yesterday to discuss my plan in depths. The representative I spoke with read verbatim from the downstate medical guideline form instead of second guessing her response to me. That was interesting. Apparently, what the surgeon's office rep had said to me regarding the six mo supervised diet is seemingly certain.

Across the board, all of the BCBS plans are different and guidelines differ from state to state, in my case no supervised visit is mentioned in my policy for batriatric surgery. However, I will keep you guys posted when/IF I learn otherwise.

--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

I have an appointment with Dr Holover in Long Island, NY on January12 which would have been my 4th weigh-in had I continued with GHI PPO insurance coverage/plan. I am uncertain if I should cancel that appointment and wait till all of my paperwork is straightened out or go there to discuss surgery date. Anyway, I hope my shared experience helps someone, anyone.

[Pyrodjm 0]

I am so glad that I found this thread! My husband works for NYCTA and we are planning to start the process to be banded this year. I am SO glad to find out that Empire BCBS will cover it without having us jump through to many hoops. GHI was always a fight for everything it seemed. We will be meeting with a surgeon in a week, I'm SO excited.

What type of five-year weight history was required for them? Medical records or could we just fill out our weights for some years? My husband has only been to the doctor a handful of times in the past 10 years.

[EliyshevaLovesYahweh 6]

I am so glad that I found this thread! My husband works for NYCTA and we are planning to start the process to be banded this year. I am SO glad to find out that Empire BCBS will cover it without having us jump through to many hoops. GHI was always a fight for everything it seemed. We will be meeting with a surgeon in a week, I'm SO excited.

What type of five-year weight history was required for them? Medical records or could we just fill out our weights for some years? My husband has only been to the doctor a handful of times in the past 10 years.

Pyrodjm, seems we have something in common Congratulations to you both for the fist step toward the WLS. If you don't mind my asking, what type of plan do you have with Empire Bluecross Blueshield? Apparently NYCTA decided to go with direct point of service for some of their employees who were transitioning from GHI PPO to Empire BCBS regardless of their geographical position. I am upstate NY. One question though, are you certain that E-BCBS requires a 5 year weight history? Will have to call them up about that. If so, I have been told by my PCP that he will do his utmost best IF I need anything re this Lap Band journey to get approved - that is reassuring.

[EliyshevaLovesYahweh 6]

error

[Pyrodjm 0]

We DO have lots in common, sent you a private message.We have the Direct POS plan, whatever that mean. We just switched over on the 1st. I have no idea if a weight history is required for me. Just read on here that many folks needed them.

[EliyshevaLovesYahweh 6]

We DO have lots in common, sent you a private message.We have the Direct POS plan, whatever that mean. We just switched over on the 1st. I have no idea if a weight history is required for me. Just read on here that many folks needed them.

Neat! I've received your private message and answered. Keep in mind that every plan is different and every case as well. Empire Bluecross Blueshield reviews cases independently. Hope things work out with you.

[kr8160311 36]

was googling Empire BCBS and I found you all! I'm so glad I did I love this board! BCBS requirements now seem pretty easy see link below

http://www.empireblue.com/medicalpolicies/policies/mp_pw_a053317.htmI

I have not been on a pcp since I was 18 and my OBGYN since my last birth which was 5 years ago ( they don't have records anymore) The only thing I can provide to them is my most recent visit to my new pcp and letter of medical nessissity and a BMI of 42.1 along with other requirements phy, nut,consult, etc.. I do have a letter from my foot dr from last year stating I was 220 lbs. Anway, I know you girls are far out now at least two years and I thank you for making this process much easier now for people like me.

My last appt is on the 9th and drs office said she will send out on the 10th. Do you think my lack of having years worth of pcp will hinder my approval? Looking at there requirements it does not seem they need it just as long as my pcp deems this. Thoughts? Also how is everyone doing two years out??

My husband is Union Carpenter in NY and I'm under his ins. THANK GOD!!!

[kr8160311 36]

I also have empire bcbs ppo not sure if I mentioned that.