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Empire BCBS?

VSGandMe2011 (DisneyMomma)

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VSGandMe2011 (DisneyMomma)    20

VSGandMe2011 (DisneyMomma)
Posted

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!

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Caramel    0

Caramel
Posted

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.

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VSGandMe2011 (DisneyMomma)    20

VSGandMe2011 (DisneyMomma)
Posted

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!!!!

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Caramel    0

Caramel
Posted

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.

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mp8btpc    33

mp8btpc
Posted

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

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Caramel    0

Caramel
Posted

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.

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VSGandMe2011 (DisneyMomma)    20

VSGandMe2011 (DisneyMomma)
Posted

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!!

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morethan    4

morethan
Posted

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.

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Go To Topic Listing Insurance & Financing

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    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. LeighaTR

        LeighaTR

        I hope your surgery on Wednesday goes well. You will be able to do all sorts of new things as you find your new normal after surgery. I don't know this from experience yet, but I am seeing a lot of positive things from people who have had it done. Best of luck!

    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

      CaseyP1011

      Officially here for a long time, not just a good time💪
      · 0 replies
      1. This update has no replies.

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