Does anyone have experience with GHI covering Lap-Band?

on 1/26/07 1:52 pm - Long Island, NY

Good evening: I am currently covered under Anthem BC/BS but there is a small business policy exclusion with my specific plan. My employer has offered to purchase a separate policy for me, providing it's around the same price as my current policy. I live in NY and found a policy with GHI (Alliance Value Plan) They tell me they cover the band if it's "medically necessary" I know I will have no problem meeting the requirement but it makes me nervous that they won't give me many specifics about coverage related to WLS until I purchase a policy. I'm hesitant to cancel my BC/BS policy in favor of this GHI plan because the one catch to the GHI plan is, it doesn't cover office visits. That would all be out of pocket cost.  I am starting a 6-month doctor supervised diet next week (my doctor's office says it is a requirement for  GHI) and have an appointment with the surgeon in two weeks. Any words of wisdom or advice re: GHI coverage? Thanks

gary viscio
on 1/28/07 4:00 am - Oceanside, NY
RNY on 07/01/03 with
They cover it.  It should say so on their website, it used to. Email me privately if you need assistance.  GHI NY does pay.  I can show you approvalletters after appeal. Gary
Gary Viscio
RNY 7/1/03  -166lbs
on 1/28/07 7:52 am - Long Island, NY
Thanks Gary. We actually played phone tag after I emailed you guys about 2 weeks ago, in reference to trying to beat the BC/BS exclusion for WLS but I've since decided to go with the GHI plan instead. If I run into any problems I will contact your office.
on 1/29/07 8:15 am - Long Island, NY

Gary: I was told by my doctor (PCP) today that GHI is merging with HIP. I was told by GHI the plan will be the same but they want me to buy a policy so they are going to tell me what they think I want to hear. Any experience with HIP? My doctor's office said HIP is a nightmare to work with!!