Anyone with GHI success in NY??

daniela531 · August 6, 2005

Hi Everyone,

I am going to be banded on 9/9/05. (nervous wreck). Anyway I am paying a discounted rate because I am entering a clinical trial for those who have a BMI below 40 and do not have "significant" comorbidities. My husband, however, does have a BMI of 40 and moderate HTN. He however has GHI through the NYC Sanitation Dept which excludes the Lap band but covers the bypass (according to the physicians office he is going to). Has anyone ever appealed and had success with GHI where it excluded lap band surgery. He does not want to do the bypass. I would appreciate any input anyone has. He has the option to chose another insurance during open enrollment in Sept. His choices are Aetna HMO or QPOS, CIGNA, Empire EPO or HMO NY, GHI HMO, HealthNEt, HIP Prime HMO or POS, MetroPlus, or Vytra.

He currently has GHI CBP/Empire BC/BS for hosp,which, like I said, excludes the Lap Band.

Anyone know which is the best for the Lap Band??? We had decided to pay for his too which would leave us pretty broke but what's money in comparison to health right? I'd rather get it covered if possible. Again thanks in advance for any support you can give. I would be so happy if we could do this together.

Chris S. - L.I. · August 6, 2005

Daniela.

I had my surgery back in 2003 and I have GHI CBP. I did hear that they were not covering it anymore but I would go to the Yahoo group Bandsters INsurance and check there. Who is the surgeon? Also, I think you can probably win on an appeal if you got an attorney involved.

Chris

porclndoll · August 6, 2005

Hello There.

I have GHI HMO....and I was approved within 3 days of my paperwork being submitted. No need to appeal for coverage. I had the band surgery done on 05/05/05....AND I live in New York.....I used Dr Kwons office in Port Jervis NY..I have no idea what part of NY your in. I did have a BMI over 40, I was 100 pounds over weight, I did have some comorbidities....and GHI HMO approved it. Thank God because this is the BEST THING I have ever done for myself. I hope this is helpful.... Good luck to you and your hubbie!

TTYL

daniela531 · August 7, 2005

Thanks for the info. I think he should choose Healthnet during open enrollment - I heard they are the easiest. I am having my surgery with Dr. Christine Ren at NYU. Depending on his insurance my husband would like to go with Ren or Feilding also (they are partners) , or Macura (not sure of spelling). We are from Brooklyn, NY. I don't want to go through the appeals process if we can avoid it. Thanks again.

dosnyc · March 30, 2008

I am also GHI and retired from Sanitation. I am in the process right now and the first response I got was that the documentation was not complete. My doctor is resubmitting. I can tell you living in Florida and using GHI is not the easiest thing to do. they literally torture you at times. Rght now I am just praying that they accept the documents and I don't have to go through another six month wait.