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Anyone have Empire Plan NYSHIP -United healthcare ?

dlfnjgirl

By dlfnjgirl, in Insurance & Financing

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dlfnjgirl    6

dlfnjgirl
Posted

Hi everyone! Just had my consult with my surgeon today. I have my first nutritionist appt on 2/12. Dr said that I should go to him to be weighed before each nut. visit. I also have to get the psychologist appt in as well.

For those who have my plan, did the insurance cover the Nut visit and psych visit?

Also what other hoops do I have to jump through to get approved? My BMI is 41 and don't have any comorbidities (thankfully, although would help for insurance approval)

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KristenLea91    13

KristenLea91
Posted

I have the same insurance. I had to have 6 months nut visit, upper GI, EGD and psych eval. No issues with getting approved for surgery. BMI was 42. They covered EVERYTHING. I only I had to pay my copay :) i was sleeved on 1/6/16.

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KristenLea91    13

KristenLea91
Posted

I believe it was my doctors requirements, to check if there is anything else (hernia) that would need to be fixed as well.

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dlfnjgirl    6

dlfnjgirl
Posted

Thanks KristenLea. I was just told by uhc resolution unit that my surgeon should send in his recommendation and whatever documentation indicating why I should get the surgery to the pre-determination unit and because of my 40+ bmi I could possibly get approved without the 6 month diet. Even though I don't have any co-morbidities...yet. I do have a history of hypertension but for some reason I don't anymore, even though I stopped taking my meds 3 years ago.

Congrats on your surgery btw! How are you feeling?

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KristenLea91    13

KristenLea91
Posted

That's great! Even with the 6 month visits, it went so fast.

I feel great. I'm in the pureed stage. Surgery really didn't cause me any pain either. Unless I'm just a great healer. I am down 22 pounds since surgery, can defiantly feel the difference. I'm not regretting it at all :)

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dlp712    11

dlp712
Posted

Can anyone help with United Health Care Choice Plus? Their approval process. I have an appt with surgeon next Wednesday. I have a BMI 35 I am a diabetic, sleep apena, high blood pressure and if that's not enough. One kidney ....

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KristenLea91    13

KristenLea91
Posted

@@KristenLea91 - who was your surgeon and how much out of pocket did you have to pay?

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I had dr. Ramon Rivera from tristate bariatrics in suffern ny. I only had to pay my co-pays, which was 20 dollars for the office visits, and my surgery was the beginning of the year so I didn't have to pay anything at the hospital. It was great.

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Killian    270

Killian
Posted

I have HIP Prime in New York. I have a 4 month wait...Need psych eval too. Everything is covered. I can wait the 4 months..it is good practice and gives me time to read these forums and You Tube video of fellow sleevers. Use the waiting period to your advantage.

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Slick300    1

Slick300
Posted (edited)

Jumping in on this older conversation because I am a NYS employee with the Empire Plan and am wondering how your experience went @@dlfnjgirl? My consult is 1/6/17.

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Edited by Slick300

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dlfnjgirl    6

dlfnjgirl
Posted

I had to do 6 months of doctor supervised diet since I didn't have weight watchers or Other diet program within the last 2 years. I had my surgery (sleeve) October 6. Also needed psych eval but approval was pretty smooth. Good luck to you. What agency you work for?

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izzy13    117

izzy13
Posted

I work for the state too, when I had my first dr visit I had the empire plan but decided to switch to cdphp last year during open enrollment. Cdphp is easier if your bmi is over 40, they don't require the 6 mo supervised diet.

With a lower bmi and comorbidites I had some issues but was finally sleeved October 12th it's been the best thing ever!

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Go To Topic Listing Insurance & Financing

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    • Alisa_S

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      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.
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      1. LeighaTR

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        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💪
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