New here, need advice

Hi all, I am new to OH and want to have WLS. I have an appointment on April 10th at Albany Medical Center to learn more. I am worried that my health insurance will not cover the surgery though. Any body else have Blue Shield of NENY? What has been your experience with them as far as getting approval? I have a BMI of 42 and have treid many different wieght loss programs (WW, Jenny Craig etc..) The most I was ever able to lose is 28 lbs. And always gained it back plus some despite my efforts. Any advice would be appreciated. I am so glad I finally found a place I feel confortable discussing this Crystal

I would suggest that the first thing you do is contact your insurance to find out if they do in fact cover the surgery and what there requirements are. Many insurances require documented Dr. supervised weight loss attempts for 6 months or more. Good luck on your and keep us posted. Rachelle

Call your insurance and make sure that wls is not a benefit exclusion by your employer. Next make sure they tell you all of the pre determination requirments. Once you secure that information you can take it from there. I live in Virginia now but I am from NY. I have had surgery at Albany Med and they are wonderful. Best of luck to you. Necole

Welcome to OH! The people here are so supportive and sincere. And usually if you have a question or problem someone on here has been there and done that. I don't know about the insurance coverage like the others said it is best to call and find out and be sure to get the name of the person you speak with. Best of luck on your journey. NoraLynn

well... blue shield NENY will cover WLS, as seen here... http://www.bsneny.com/neny_dspy.php?file=neny_prov_prot_070106d.html that page also gives their criteria, which is pretty standard (BMI requirements, documented attempts, etc) the only thing you really need to do is, as someone above mentioned, call your blue shield office with your specific info (usually your employer name, and your SS #) and see if there is a written exclusion for WLS. if your employer chose to exclude WLS to save a little money on premiums, your beef then is not with Blue Shield, but with your employer. your only recourse in that case is to beg and plead with your company's benefits coordinator and ask them to either change the policy entirely, or see if they can make a one-time allowance. Good luck.

Thanks for the link and the extra info it was very helpful. Crystal

Contact your insurance company yourself. Get their qualifications. I had BC/BS and they covered everything, but I was required to lose 5% of my weight forst before an approval was given. Keep me posted. If you need help, just email me personally. Marie

Thanks for he advice. I will email you if I have any questions. Thanks again. Crystal

Hi, Congratulations on making this life changing decision. I am having my surgery on 4/2/07 at Albany Med and they have a wonderful program. The people are so helpful and kind. They have a pretty strict program to follow, including losing 10% of your body weight before you can be referred to a surgeon, but they help and guide you along the way. They have support groups every Thursday night from 6-8pm. Feel free to stop in and listen to what people have to say about their pre-op and post op experiences. You don't have to wait until you have your orientation to go. Good luck and don't hesitate to contact me if you have any questions. Janet

I am so happy for you. I can't wait until I'm there. I definetly will get to the support group I think that it will be very helpful to be able to hear others stories good or bad. Good luck with the surgery and keep us posted. Crystal