Empire BCBS NEW YORK

[Bedwards32 98]

I'm just beginning my journey and my first appointment is 6/29. All the ins stuff really confuses me! Does anyone have this type of insurance and know what "hoops" you have to go through?

[Teesaa 30]

I have NYSHIP Empire. I am going for my first appointment on friday 6/12. I called the insurance company directly and they stated all I needed was a letter of medical necessity. My doctor also has his minimum requirements. Referral from PCP, Psychiatric, Pulmonary, and Cardiac clearance. Plus 2 months minimum nutritional counseling. Wish me luck!!

[Bedwards32 98]

Good luck! I called my ins directly also, and all I got was I had to go to my first appt they also gave me a # for the Dr's office to call after my appt. more confusion than anything ????

[Teesaa 30]

Yes confusing for you and so frustrating. I believe Insurance companies make people jump through so many hoops to put them off following through with surgery. Good luck on the 29th.

[bmc 2]

I have NYSHIP Empire. I am going for my first appointment on friday 6/12. I called the insurance company directly and they stated all I needed was a letter of medical necessity. My doctor also has his minimum requirements. Referral from PCP, Psychiatric, Pulmonary, and Cardiac clearance. Plus 2 months minimum nutritional counseling. Wish me luck!!

I have NYSHIP too. Long story short is last month they changed the policy, you need 6 continuous months with a nutritionist and counseling.

[Teesaa 30]

Thanks for the update on NYSHIP. I wasn't expecting 6 months. I am disappointed as I specifically asked if there were any other requirements beside a letter if medical necessity and they said no. This was only 3-4 weeks ago!! I guess it is what it is. I still have to follow the road..... and focus on what I have to do.

[Sharon1964 2,530]

Call them again and ask them to send or fax you their medical policy for weight loss surgery. Also ask for a benefits booklet, and ask specifically what page of the benefits booklet covers weight loss surgery.

[Mom26 313]

We also have Empire BCBS - and was told there is no longer a 6 month wait as of May 1st for those who fit certain criteria. I unfortunately do not fit under that criteria and need the 6 month journey.

[Teesaa 30]

I must meet the criteria as I met with the surgeon and his staff on friday. And they told me all going well with clearances and pre ops I could have the surgery by mid to late August. The first visit to the surgeons office was a good experience. I feel I am in good hands but I am both terrified and excited.

[Bedwards32 98]

Looks like I will be starting my 6 month journey ???? hope it goes quickly!

[Teesaa 30]

Last week I got a call from my coordinator stating NY SHIP Empire BCBS Insurance changed last month. BMC you knew before they did!! Six months supervised diet is now part of the requirement. They are going to try and submit weight watchers documentation with notes from my regular doctors visits to see if that will suffice. Doctors visits were at least every three months for the last three years. The weight watchers documentation is about 1 + 1/2 years out of the last 2 years. If not, its looks like a December date for me. I'm doing a whole load of medical tests right now so after my July visit with nutritionist they will submit it to the insurance company.

[BeginAgainDay 6]

I have BCBS in NC. The process is lengthy. Just make sure you have Letter of Medical Necessity from PCP with documented 4 year weight loss history, along with weight loss programs you have tried and the results. That has been the most cumbersome part of my journey. I never documented anything I did on my own in detail. I had to get my records from different doctors, and have one doctor combine everything on one letter. I still don't know if I am approved or not.

Edited July 11, 2015 by BeginAgainDay

[Teesaa 30]

Thank you for the advice. Luckily I had a lot of my medical records. I compiled a weight history chart plus what I call my medical resume. As I went along I brought both records to each doctor I needed medical clearance from. I have my next nutritionist visit on Friday. there is a hold up with doing a sleep Apnia test. I went to the doctor two weeks ago he wanted to repeat I hope I have an answer by early August.

[Teesaa 30]

How long are you waiting for answer?

[BeginAgainDay 6]

My surgeon just submitted to insurance on Friday.