Empire Blue Cross Blue Shield

jOANNE · November 5, 2003

HAS ANY BEEN APPROVED FOR SURGERY THAT HAS THE EMPIRE BLUE CROSS BLUE SHIELD INSURANCE. MY INSURANCE WILL CHANGE AS OF THE FIRST OF THE YEAR. I UNDERSTAND THEY ARE DIFFICULT TO DEAL WITH. NEED TO KNOW IF ANYONE HAS GOTTEN APPROVAL AND WHAT THEY ARE LOOKING FOR.

THANKS,

JOANNE

Alexandra · November 5, 2003

Hi Joanne,

I don't have any specific information, but I do know that Empire BCBS in CT has paid for the lap band on several occasions in the past. Whether those were the result of appeals, or were from large groups with friendly contracts, I don't know. A lot depends on how you're covered and what kind of contract it is. But on the whole I think it's a fairly band-friendly carrier, as compared to others who exclude it entirely.

Good luck!!

jOANNE · November 5, 2003

Thank you. You made me feel so much better. I have been stressing myself out about it. Now I can relax. Just as long as I know they have approved some. Even if I have to appeal that is okay.

You are always so helpful Alexandra. Thanks, Joanne

Stregamama · November 9, 2003

My insurance is BCBS HMO. I was denied because the band was considered "investigation/experimental". I hired the Lindstroms (Obesitylaw.com).they submitted the remainder of my appeals and still I was denied. The great news is that a State external review overturned the denial and I was banded 9/03

jOANNE · November 9, 2003

THANK YOU SO MUCH FOR YOUR RESPONSE. IF YOU DONT MIND, CAN YOU TELL ME HOW MUCH THE COST WAS FOR LEGAL REPRESENTATION?? JUST IN CASE I NEED TO DO THE SAME.

November 9, 2003

Empire BC/ BS PPO turned me down in July stating the lapband was "investigational". But as of October 1, 2003 they changed their policy and started approving the surgery. I was banded on October 28th. The rep told me that the proof of the band's effectiveness is overwhelming!

As for the Lindstroms, they charge $450.00 for an appeal.

Good Luck on your journey, Diane