Anyone have Empire BCBS ???

Brittany H.
on 3/30/14 10:51 am

I have Empire BCBS out of NY through my mother's work- company based in NY (I'm in North Carolina). Does anyone else have this insurance and had VSG or working towards it??????

5'3" HW:295  CW:283  GW:145

 

    

mwall81
on 3/30/14 11:17 am - MI

I work in medical billing for hospitals across the country, I recommend you always start with your insurance for coverage questions.  Everyone's plan is different even though they have the same provider, so unless it's someone that works with your mom, they will not be much help for you.

 

Contact BCBS at their customer service line and ask them to send you their requirements for surgery if they even cover it.  Some plans that are offered exclude bariatric surgery.   They will be able to tell you if its covered, what their stipulations are, and what to expect to get through the process.  I know BCBS can be a pain in the arse (I deal with them all the time for work) but just hang in there, and the wait time will surely suck, so try hitting up their website to see as well.

Live like your dieing, love like you've never been hurt, dance like no one is watching.

        
Brittany H.
on 3/30/14 11:43 am

Thank you for the reply. I have called my insurance 1800 number for customer service a few times now. each time they have directed me to the online policy for WLS coverage. I have already confirmed with them that it is in fact covered if the criteria on the policy is met(http://www.empireblue.com/medicalpolicies/policies/mp_pw_a053317.htm) . What i am having trouble figuring out is if there is any additional guidelines i have to meet or provide for them for pre authorization approval- like you said- whatever is written into the specific contract for the company my mom works for.- is there a specific department at my insurance i should be asking for that you know of to find out these details? should i ask for the policy for said company i.e requirements for Cushman & Wakefield's medical policy?  thanks for your information already provided! I will be calling them tomorrow with plenty of patience i hope!

Kelly Jean
on 3/30/14 11:32 am
VSG on 04/08/14

I have bcbs through my company and my husband has it on the family also ...mine doesnt cover the surgery ...but his does....both bcbs.... so like said above   they are all diffrent ...good luck .....

  

danixbanani
on 3/31/14 2:45 am - NY
VSG on 10/12/12 with

Like the poster said above, you should really talk to the insurance company about all your questions. Plans can be different based on who the employer is providing the plan.

I had Empire BCBS and they covered my lapband surgery, my lapband removal, and my VSG surgery.  Also, your surgeon's office coordinator should be able to help answer some of your questions concerning insurance.  I know that before lapband and VSG, I had to do 6 months of doctor's visits and a supervised diet before being approved.  Good luck.

band to sleeve revision and loving life!

You do you, and I'll do me

mwall81
on 3/31/14 11:34 am - MI

Based off the information on your web link, it appears that they do cover it under your mom's plan.  Let me see if I can break it down for you a little easier:

 

You qualify if your BMI is 40 or greater.  If it is under a 40, it must be above a 35 and you must have a comorbidity present (IE Diabetes, high cholestorol that your on meds for, or high blood pressure, or sleep apnea that is being treated with a device ((Those are the big 4)).

 

You must participate in a supervised weight loss program approved by your physician, I'll fore warn you, most do NOT included Jenny Craig, Weigh****chers, or any other diet programs out there.  Its best to consult your PCP on this.  As for the specifics of how long, you'll need to contact BCBS for that, but most require atleast 6 months.

You must pass a psych eval, nutrition counseling, essentially the entire preop hoopla for insurance here.  If your PCP can refer you to a bariatric surgeon, most of them can hand hold you through this entire process.  As long as you meet the above criteria, you shouldn't have to many surprises.

 

From what I understand, denials from the get go are common.  Don't get discouraged!  Appeals are always available to you through your insurance :)  If you'd like feel free to email me, I know a thing or two about getting around some denials for insurance, and I"m always happy to help fellow peeps in their process :) 

Live like your dieing, love like you've never been hurt, dance like no one is watching.

        
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