City of New York employee - Empire BCBS & GHI

Mimi N. Y.
on 7/6/09 2:29 pm, edited 7/17/09 9:28 am - New York, NY
  Hello, I've been visiting this board for a couple weeks and first I have to say thanks to everyone!  I've learned so much here, it's incredible.     I have Empire BCBS (City of New York employee) and called them to find out what  the pre-requisites for surgery are.  The man I spoke to said that there is a 6 month waiting and then went on to say that I'd have to see a nutrionist as well as a psych for an eval.  (My BMI is 41.5).   Does anyone here have Empire BCBS City employee package? If so, did you have to wait 6 months?  And when you see the Nutrionist, do you HAVE to lose weight during the 6 months or are they trying to see that if you continue to see a Nutritionist that you can eventually lose all the weight?  Cuz I can damn well lose weight, have done it a dozen times, but am better at gaining   Anyhow, any info is appreciated.  I've searched for the boards for NYC employees with Empire BCBS but came up empty.  BTW, I am looking to have the VSG at Lenox Hill.  I will be attending a seminar there tomorrow re: bariatric surgery.   Thanks in advance!

(also posted this in the VSG forum)
(deactivated member)
on 7/7/09 3:24 pm, edited 7/7/09 3:24 pm - Fat City, NJ
 Are you sure Empire covers VSG? I am an NYC employment and I don't think they covered it though I could be wrong.
Mimi N. Y.
on 7/7/09 6:46 pm - New York, NY

Ricco, I went to the seminar tonight and was told by the insurance person at the seminar that I will prolly have to fight Empire BCBS for the VSG.    I meet the requirements but the procedure I want is still considered somewhat "experimental", eventhough it's been performed for years (specifically with cancer patients, etc.).  Anyhow, I will be making an appointment with the doctor since they want you to attend the seminar first.  I will post follow-ups as they happen.  I am not interested in any of the other WLS as the VSG I believe is the best one for me and my lifestyle. 

on 7/7/09 8:33 pm - TX
Most BCBS plans require a six month supervised diet.  They want to see that you can stick to a plan, lose and maintain the weight loss prior to surgery.    I started with a BMI of 41 and lost 20 lbs on my 6 month diet.   

You should be able to access your policy manual online to get your list of requirements.  Go to the BCBS website and search for "Surgery for Morbid Obesity". 
Mimi N. Y.
on 7/16/09 8:42 pm - New York, NY
Found out at my consultation today that GHI would be picking up my bill for a VSG. I read GHI's requirements online and I meet all of them.  Once I'm done with sending my doctor additional paperwork/testing they will send to GHI for approval.

(deactivated member)
on 7/17/09 6:26 am - Fat City, NJ
On July 16, 2009 at 8:42 PM Pacific Time, MimiNY wrote:
Found out at my consultation today that GHI would be picking up my bill for a VSG. I read GHI's requirements online and I meet all of them.  Once I'm done with sending my doctor additional paperwork/testing they will send to GHI for approval.

 so do they cover it for sure?  get it in writing
Mimi N. Y.
on 7/17/09 9:26 am - New York, NY
It is on the GHI website.....go take a look for yourself. 
(deactivated member)
on 1/1/11 10:15 pm
I tried finding the GHI requirements for weight loss surgery on the GHI website but was unsuccessfull. What did you do to find the these requirements.  Please advise
on 3/10/10 3:02 pm - Bayside, NY
Revision on 04/07/10 with
Just read your previous post and noticed that GHI will pay for your sleeve....I work for the NYC dept of education and I am waiting for approval to the sleeve....did they approve and pay for your surgery.....thank you for any information you can provide...I am very anxious....God Bless.....Susan

on 3/23/10 7:44 am - New York, NY
 Hi Everyone,

I am trying to get started on this road toward lap band surgery.  I work for NYC and have GHI insurance, which requires the 6 month diet... though I've been on one for longer than that, it hasn't been physician supervised so I'm trying to get that started.  I am seeing a surgeon for a consult today at Beth Israel.  I'm hoping everything goes relatively smoothly and that I'll be able to have the surgery quickly after the 6 month supervised diet.  

I am a 28 year old male, 262 lbs, BMI 41.2, hypertension, GERD, facet arthritis in back, asthma.  I think I meet all the criteria.  My only concern is that I have taken steroids (prednisone) for asthma, so I hope that doesn't complicate things too much.

I'm wondering if anyone has any tips for working with this, especially anyone with experience with GHI.

on 11/5/11 9:07 pm - NY
VSG on 02/14/12
I see that you have reached your goal-CONGRATULATIONS!!! Also, I am a City of New York employee who also has GHI/BCBS and from your posts we appear to have very similar BMIs . I am still pre op but hope to have surgery very soon since i have completes all pre op testing and the 6 month weight monitoring. Any advice and/or experiences you can share are greatly needed and appreciated. I see you havent posted for some time but hope that you will see this post. THANKS IN ADVANCE!!!
on 3/20/12 5:18 am - mount vernon, NY
I have the same insurance GHI/BCBS and they are making me jump throough hoops.
on 9/25/10 5:40 pm
How did everything work out with you?  I too have GHI (PPO) with a BMI of 40 and was wondering if they will give me a hard time to get approved.  Thanks in advance.