Empire BCBS?

[VSGandMe2011 (DisneyMomma) 20]

I was just wondering if anyone else has Empire BCBS? Several BCBS companies changed their policy toward VSG, but mine hasn't. I'm just starting this process (just turned in my ins packet to my dr's office) and wondered if anyone had any experience dealing with Empire BCBS (mine is a select ppo). Thanks SO much!

[Caramel 0]

I have BCBS Empire Blue PPO from my husbands company and they told me that they cover the surgery, I just have to submit all the required documentation, past failed weight loss attempts, psch eval, doctor letter stating no endocrine disorders and nutritional eval. And now Im just waiting for the approval from the insurance. BCBS told me that the doctor just calls in a PR (prior authorization) for the surgery and everything is done over the phone in a matter of minutes. Im hoping to have the surgery in December, I'm just waiting on the doctor to call me back.

[VSGandMe2011 (DisneyMomma) 20]

Wow!!! That's WONDERFUL!!! I'm waiting to hear back from my dr's offce and I won't be financially ready until February 2011, so I'll have plenty of time to get the extras done! Thanks for the good news, Caramel!

[VSGandMe2011 (DisneyMomma) 20]

Anyone else????

[VSGandMe2011 (DisneyMomma) 20]

Ok, I figure I won't be the only one wondering about Empire BCBS (my hubby works for Sears Holding) so I thought I'd just keep updating this thread with how the process works for me!

I just got my letter from my Dr's office and I have 3 documentation requirements before they will submit my request for approval.

1. Psychiatric evaluation

2. One-time diet consultation

3. A pre-operative sleep study

Does anyone know how much these things will cost me?? I'm really excited that this is all they need! Pretty simple! I won't be able to do these things until January (Christmas is taking all our extra $$), but I'm so excited that it seems to be pretty simple!! WooHoo!!!!

[Caramel 0]

On my psych eval, I had to pay $30 copay. I had to have a nutritional eval and that was free at the surgeons office were I am having my surgery. I did not have a sleep study, but I did have to have 6 months of supervised dieting which I had been doing off and on since the year 2000! I am hoping to have my surgery down before the end of December. I am waiting on the psychiatrist to fax my psych eval which was done 3 weeks ago. I am so disappointed in her right now. I could have had a date by now. Good luck on your journey.

[mp8btpc 33]

Good luck to both of you on the journey. I am not sure how much a sleep study would cost and the insurance may cover a good portion of it as it is being ordered by the doctor.

Keep us posted.

I'm a Disney fan too! I LOVE DISNEY!! YAYAY

[Caramel 0]

I just heard back from the insurance on Friday, Dec 3rd and they told me I was approved. I am so happy! Now I just have to wait until the dr office calls me with my date. I think it is the last week in December.

[VSGandMe2011 (DisneyMomma) 20]

Caramel - That's awesome!!!! Congrats!!

AFM - I scheduled my sleep study for the beginning of January and that will take care of my deductible, then I just need to look at getting my NUT appt and psych eval scheduled!! YAY! The ball is rolling!! Yippee!!!

[VSGandMe2011 (DisneyMomma) 20]

Ok, I called and got my NUT appt and psych eval scheduled!! I'll be ready to submit everything to my insurance company very soon after January 12th! WOW!! I'm so excited! AND here's the AWESOME part.......(drum roll please...)

Empire BCBS now covers the sleeve!!!!

"Medically Necessary:

Gastric bypass and gastric restrictive procedures with a Roux-en-Y procedure up to 150 cm, laparoscopic adjustable gastric banding (for example, the Lap-Band^® System or the REALIZE^™ Adjustable Gastric Band), vertical banded gastroplasty, biliopancreatic bypass with duodenal switch, and sleeve gastrectomy (open or laparoscopic) are considered medically necessary for the treatment of clinically severe obesity for selected adults (18 years and older) who meet ALL the following criteria:"

YAY!!!!! Can I do a happy dance?!?!!!!!!! WooHooo!!!!! Just had to share!!

[azjen13 0]

Do you know what the requirements were? We have Empire BCBS too and I am just starting my research.

[VSGandMe2011 (DisneyMomma) 20]

Here's the Medical Policy they referred me to! HTH!!

http://www.empireblue.com/medicalpolicies/policies/mp_pw_a053317.htm

[morethan 4]

My case was submitted the first week of January and I am still waiting for approval. I am getting nervous. It's been 12 days. I don't know what is taking so long. I read that some people got their answer within a week and then I read some had to wait the whole 30 day (which I am told they have 30 days to respond). I was hoping to have my sleeve done the 1st of February. I really want this; no, I really NEED this. I am praying for a response of approved. Prayerfully it will come this week.

[VSGandMe2011 (DisneyMomma) 20]

Have you heard anything, Morethan?? I'm waiting for approval now too....it's been a week!

[VSGandMe2011 (DisneyMomma) 20]

I was approved today! It took 9 days! YAY! Hoping to get my surgery date soon!