Question:
Is there anytype of wait once you have insurance?
I recently got married. My husband has insurance, but I will not be able to join in on his insurance till Oct. He has Empire Blue Cross Blue Sheild. I am axious to know is there a waiting period or a claus with this insurance of a wait period or denials for a pre-existing condition such as morbid obesity? How hard is it to get them to ok the surgery?? Anybody out there know? — earth-angelsc (posted on May 21, 2007)
May 21, 2007
You might want to start with a diet supervised by your physician... most
insurance companies want a 6 month diet history. So that will be
something to get started on now if you can.
GOOD LUCK
Susan
— sallyone
May 21, 2007
it depends on your dr. and how fast they push it threw me. i had a
consultation dec 5,2006 and i was given my surgery dat for feb 1,2007. just
7 weeks for me
i guess i expedite matter by being prepared . fast because i brought in my
medical record . from previous dr. that i vist for weightloss. so i got
aprove instantly. i have amerithealth.
good luck.
— yvettetas
May 21, 2007
I can't answer your question and probably no one can at this point as even
with the same insurance company, the plans can differ from employer to
employer. It all depends upon which plan your husband's firm went with.
You can get some answers from his benefits office. There are 2 really good
books that have chapters devoted to getting approved and appealing
denials... they are as follows
The Doctor's Guide to Weight Loss Surgery and Gastric Bypass Surgery. I
refer to the first one all of the time in answering questions here and for
reviewing for myself. Good luck to you.. As the other poster said.. start
getting your weight loss attempts documented. If you have done some in
thepast see if you can return to those centers and get the records from
when you went. Then start a program now.. you can try any of them out
there, just make sure that you are seeing your physician periodically so
that they can document your weight and what you are trying whether it be a
formal program like Weight Watchers, Jenny Craig, LA Wt Loss or just
dieting and exercising using low carb high protein diet.
— Kari_K
May 21, 2007
I agree that you need to get on a weight loss plan asap & see your pcp
right away. My husband's BCBS of IL required 1 yr, though I think 6 mo is
most common. I did Jenny Craig. The Ins Co had an approved list of plans.
The big secret for me, was in seeing the Dr. Every time I went, once a
month, the FIRST thing I was there for was Weight management. The Dr wrote
that on the notes FIRST & Coded that FIRST on every visit, regardless
of what else we needed to talk about (be that my cold or my medication,
etc).
The second big assist for me, was getting a copy of the pages of the
contract from customer service, that had to do with the surgery.
Good luck. God Bless. If you have problems with the ins, send me an email.
Mickie
— asinmouse
May 22, 2007
Hi Sheryl. You have to contact his insurance carrier and ask. Insurance
companies have tons of different policys. If they do cover it, they may
have obligations to meet to get the benefit. His company may have chosen a
plan that does not cover wls. Even if the company does cover wls, your
husbands work may have chosen a policy that excludes it. Contact Empire
and ask your questions there. They will be honest with you, and will know
everything eventually anyway when you come on board. You can't hide that
you are obese now, it will be known. It may or may not be considered
pre-existing. Since obesity is not considered a "condition"
unless you are on disability (I think), I don't know if it is a pre
existing anything. Ask them about how long it takes to get approval and
their requirements. You should have a good relationship with them when you
get on board anyway, so ask. Your husband may have to call and ask, or
sign a document to let you have access to information, but do what you need
to and get real answers, not guesses from here. We can only guess for you,
but you can know by calling. Take care. Patricia P
— Patricia P
May 23, 2007
My husband and I have Empire BCBS through the hospital that he works for.
They have a waiting period of 6 months from the time you speak with the
surgeon (and he bills them for it) until you can schedule your surgery.
Also, the nutritionist and the psychologist are not covered for their
appointment to write you a clearance letter (both were $250 for me). Just
call the number on the back of your card and they will explain everything
to you, that's what I did. I agree with the other posters though,
everything depends on the employer that is offering the insurance, there
are alot of variables with the plans. Good Luck!
— PurplePixie
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