EmblemHealth/GHI for NYC Employees

[Fusilli66 22]

I was so excited to get the call yesterday that I was approved for my surgery on 10/11! And I was so happy with the whole process. My insurance has always been GHI - CBP for City of NY Employees. Years ago I had looked into getting the surgery, but they didn't cover it at all then. Now they do (for a few years I believe). Anyway, there requirements are BMI of 40 or 35 with a co-morbidity. Also the 6 month thing and psych evaluation. Mine was 40.2 and I had 2 co-morbidites - sleep apnea and osteoarthritis (which not every insurance company accepts, but they do).

Originally my doctors office said they had to schedule surgery in order to submit it to the insurance company with a surgery date. I thought they were nuts. I asked them, what if we schedule surgery and then they deny. They told me not to worry, I had met all the requirements and there was no reason for them to deny it. They just said the only problem with GHI is that they take about 5 weeks to approve so we would schedule for 6 weeks out.

Then, once all of my doctors visits were complete and I had the clearance from the cardio and all the others I got a call from the doctors office scheduling me for 10/11 which was only 4 weeks out. I told them it was too soon because of my insurance company. But they told me, no it wasn't because GHI is now EmblemHealth and although GHI takes a long time, EmblemHealth is much quicker and thats who they were submitting it to. So they submitted last Monday and I got the approval yesterday in only 1 week! Very happy about the whole thing.

I just wish the surgery was sooner now! I just can't wait. It's 3 weeks from today and they time is going very slow but I'm sure it will be here in the blink of any eye.

So that's my insurance story for any of you GHI/Emblem people out there.

[krenee 8]

your information has been helpful because I have the same insurance through the city, and i wanted to know what the process was like with them.......

[Passion2Loose 0]

Do you know what your copay or out of pocket expenses will be for the surgery?

[krenee 8]

Well I was denied last week. I am sooo disappointed. I am calling my surgeons office tomorrow and requesting an appeal. They said I did not complete the 6month diet program

[Hibmirn 0]

Well I was denied last week. I am sooo disappointed. I am calling my surgeons office tomorrow and requesting an appeal. They said I did not complete the 6month diet program

I was denied this week for not completing the 6 month diet and for not having a letter from my pcp.