EliyshevaLovesYahweh

Pyrodjm, seems we have something in common Congratulations to you both for the fist step toward the WLS. If you don't mind my asking, what type of plan do you have with Empire Bluecross Blueshield? Apparently NYCTA decided to go with direct point of service for some of their employees who were transitioning from GHI PPO to Empire BCBS regardless of their geographical position. I am upstate NY. One question though, are you certain that E-BCBS requires a 5 year weight history? Will have to call them up about that. If so, I have been told by my PCP that he will do his utmost best IF I need anything re this Lap Band journey to get approved - that is reassuring.

Hi everyone! Yes Honk, I certainly agree. My husband is a retired foreman with the NYCTA of New York and our plan is Direct Pos with Empire Bluecross Blueshield. I have learned that although many may have the same medical insurance not all plans are the same. There is no better way to find out about one's medical plan than to call the insurer oneself. I suggest for people in question re their medical coverage with WLS: call your medical insurer 800 # (# on the back of medical card) and ask directly re what the type of plan is and coverage. If you are unsatisfied with one representative's detailed explanation of your plan, dial the number again and speak to someone else. In lieu of my uncertainties and due to my lack of courage - I took the initiative and called Empire Bluecross Blueshield yesterday to discuss my plan in depths. The representative I spoke with read verbatim from the downstate medical guideline form instead of second guessing her response to me. That was interesting. Apparently, what the surgeon's office rep had said to me regarding the six mo supervised diet is seemingly certain. Across the board, all of the BCBS plans are different and guidelines differ from state to state, in my case no supervised visit is mentioned in my policy for batriatric surgery. However, I will keep you guys posted when/IF I learn otherwise. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I have an appointment with Dr Holover in Long Island, NY on January12 which would have been my 4th weigh-in had I continued with GHI PPO insurance coverage/plan. I am uncertain if I should cancel that appointment and wait till all of my paperwork is straightened out or go there to discuss surgery date. Anyway, I hope my shared experience helps someone, anyone.

Hi nako99. I was doing a 6 month supervised diet which is required by GHI (PPO) and I had three more weigh-ins in order to comply with GHI's prerequisite for Lap-banding. However, my husband's employer changed from GHI to Empire BCBS and on Dec 31st, 2010 RD we received our new insurance cards with Empire Bluecross Blueshield (which is when I found out of the change). I immediately called the surgeon's office to find out if my new insurance was accepted and if a six mo supervised visit was required by the insurer. The rep at the office told me that Empire Bluecross Blueshield is accepted if in-network and no six mo supervised visit is necessary. I really don't know how well informed this office rep is though. Nevertheless, below are some helpful websites which I found that could possibly answer your questions. BCBS Medical Policies: http://www.empireblue.com/medicalpolicies/policies/mp_pw_a053317.htm BCBS Blue Distiinction Centers for Bariatric Surgery: http://www.bcbs.com/innovations/bluedistinction/blue-distinction-bariatric/ BCBS - Directory of Providers: http://www.bcbs.com/innovations/bluedistinction/blue-distinction-bariatric/bariatricmidlevelcriteria.pdf BCBS - Centers Hospitals (participating) for Bariatric Surgery http://www.bcbs.com/innovations/bluedistinction/blue-distinction-bariatric/bluedistinctionbariatric.pdf Hope this helps. ---------------------------------------------------------------------------------------------------------- "Just when I figured out all the answers they changed the questions"

lol. I live Upstate NY and my surgeon is in LI, NY. I travel almost three hours to seem him w/o a problem. His facility is some kind of wonderful...all of the doctors one will ever need in order to obtain clearance prior to this SILS (single incision laparoscopic surgery) band are in the same building working together with ea other - a great convenience for me. My surgeon's name is Dr. Hollover and he works together with Dr. Garber, both are certified to the gills in bariatric surgery. I have GHI PPO and Dr. Hollover is in the network for me. I do hope it all works out. Cheers.

One's decision to have this type of elective surgery should not be rushed, it should be an informed decision. I exhausted my researching ability to do this gastric laparoscopic banding for a whole year before I made the final decision to have this done. I know that the Ins Companies will exacerbate the process but one must never give up. Research the doctor of choice, make sure he is a board certified surgeon...check out if he is keeping up with the latest innovative surgery, e.g. the SILS (single incision). I believe your insurance company will reimburse you as long as your ins pays for this kind of surgery and you being the factor which qualifies for such surgery. Go to your Ins Co website and take notice of what their prerequisites are for bariactric surgery candidacy and take it from there. I am currently doing my six mo supervised diet, every month I go for weight-in - two months down and four more to go. I hope it all works out.

Hi. I am in the same exact situation you were in. How did it go with your ins? Hope you got your lap band. Eliysheva

I don't believe in coincidences, and everything does happen for a reason. The path of least resistance is trusting in Him, Our savior Yahweh Yahuwshua. May everything go well on your surgery date.

Hi. I have GHI PPO as well, however, no comorbidities and a BMI 38. How difficult is it to get approved by these people? I am currently scheduled for a consultation with Dr. Holover and am sure he will discuss a 6mo supervised diet... Let me know how things went with you. Cheers.

Hi. I know your posted thread is quite old but I wanted to ask if you were able to resolve your situation with GHI PPO? I too have the same INS coverage. Glad to say I have a BMI of 38 with no comorbidities of obesity, but rather other common overweight-related issues. Currently, I am in communication with Dr. Garber's office in re to my surgery chances here and minor set backs. Will be seen on 10/20/10. I have heard nothing but great news about that center. Anyway, if GHI won't pay...I am off to Mexico and have my SILS with Dr. Rumbaut (Lap Banding pioneer). Nevertheless, let me know how things went with you. Hope to hear it all worked out for you in the end. Cheers.

Hi! My name is Elizabeth I will be getting banded sometime in November (RD) with DR. Rumbaut. I hope it all goes well with you. Blessings.