Hi, I am a newbie. I have a questions+++ - ThinnerTimes

skyy106 · 08-03-2008, 03:26 AM

on my insurance. I have Empire BCBS. Basically, they said that I should have a BMI of 40 or BMI 35-39 but with this you have to have some illness. I have highblood pressure and high choleterol. Also, I have to have a six months medical supervised diet.

I finished the six months supervised diet. I was in a head on collision car accident late last year. Even this doctor who take cares of my lower back pain. The pain is with me everytime. She even told me that I need to lose weight because if I lost weight I will have relief.

Anyolne here have BCBS? Did they aprroved you fairly quick? If you didn't go thru your insurance. How much is gastric bypass out of pocket?

Thank you so much. Everyone here habe been so friendly. I am going to have a mental breakdown if they don't approved it. Not only am I not healthy. Walking from the master bedroom to kitchen. I get so winded. That is not normal.

Any advice would be great appreciated.

mistymee · 08-03-2008, 04:56 AM

I have BCBS (of MA) and was approved extremely quickly.. my BMI was well over 40, and I had all kinds of co-morbidities. (note the past tense of that!

)

Remember though.. it isn't only up to the insurance company... your particular policy may have exclusions for this surgery.

I just found out that the company I work for has excluded this surgery in all the other branches of our corporation, but due to an oversight, they did not exclude it for the location I where I work so I was covered without a problem.

None of the workers in an of our other worldwide locations can get this surgery right now.... After getting to talk to me for a bit, our corporate HR person said he's going to try to get that changed. (he could stand to have the surgery himself.)

Have you confirmed that your policy covers WLS?

awella · 08-25-2008, 07:17 PM

I also have Empire B/BS. I understand that it doesn't cover all Drs. I'm in Florida & Dr Jawad doesn't take it. Dr Fusco in Melb Bch does(BMI MUST be over 40) but he has a $4,000 "consult fee" and that has to be paid before paperwork goes to Ins. I am checking with 2 other Dr's in nearby area. Keep your fingers crossed for me.
Ada

skyy106 · 08-25-2008, 08:18 PM

Hi, I have my fingers crossed for you. But I recently found out from the patient advocate that they now take Empire BCBS. They are in-network now. I got approved about two weeks ago. I go for my pre-op with my doctor tomorrow. I thank god for this.

But I will pray that you find a doctor that takes your insurance.

BiGMerf · 08-25-2008, 08:35 PM

Quote:

Originally Posted by awella

I also have Empire B/BS. I understand that it doesn't cover all Drs. I'm in Florida & Dr Jawad doesn't take it. Dr Fusco in Melb Bch does(BMI MUST be over 40) but he has a $4,000 "consult fee" and that has to be paid before paperwork goes to Ins. I am checking with 2 other Dr's in nearby area. Keep your fingers crossed for me.
Ada

wow 4 grand just to see the guy.. wow

awella · 08-25-2008, 08:52 PM

Yahooooooooo Sky!! I'm so happy for you!

awella · 08-25-2008, 08:55 PM

Yes Buc--4 grand! Too steep for me!
I lived for 30 yrs in NE Pa in Bushkill midway between Stroudsburg & Milford. My kids all went to E Stbg HS and then onto ESU. My sis still lives in Marshalls Creek.

gina0922 · 08-27-2008, 11:45 PM

Quote:

Originally Posted by awella

I also have Empire B/BS. I understand that it doesn't cover all Drs. I'm in Florida & Dr Jawad doesn't take it. Dr Fusco in Melb Bch does(BMI MUST be over 40) but he has a $4,000 "consult fee" and that has to be paid before paperwork goes to Ins. I am checking with 2 other Dr's in nearby area. Keep your fingers crossed for me.
Ada

Hi Awella! Where do you live in Fla? I am going to Dr Jawad for my wls. I went to Dr Fusco's seminar and just about fainted when I found out his "program fee" was that high!! I live in Palm Bay.

How far along in this crazy process are you?

Baja Big Dog · 08-28-2008, 08:41 AM

Dont have a breakdown....be patient girl, most insurance companies will run you through the ringer before approving you. I have Kaiser, and you must go through there 6 month program prior to the surgery, but in special cases, (like back issues) they will expedite the surgery, on your word that you will finish the classes. (I don't have any idea what they would do if you don't finish the classes, its not like they will "un-do" the procedure!!).

The time issue is funny, read about almost everyone here, and they have a tale about being patient, its funny, we spent (in my case) 54 years getting to this point, and we crap about waiting for 6 months to help ourselves!!!

Before you know it you wont be allowed to start a thread in this section anymore, you will have to post in the "Post WLS" section!!!!

BiGMerf · 08-28-2008, 08:51 AM

Quote:

Originally Posted by awella

Yes Buc--4 grand! Too steep for me!
I lived for 30 yrs in NE Pa in Bushkill midway between Stroudsburg & Milford. My kids all went to E Stbg HS and then onto ESU. My sis still lives in Marshalls Creek.

kewl, yeah im in pocono lake . moved here from Brooklyn new york 4 years ago..over in wilkes barre in giesenger the program fee is 375 (and i was complaining , lol) me and the mrs plan to move to florida in the next 5 years, we love it out there