Can't take this Insurance!!!

Hi does anyone have experience with  GHI/CBP. I'm waiting for approval with my second step appeal. This is the step before i go to external appeal. I have BMI 39 and co- morbitie insulin dependent diabetes w/ complications and High blood pressure. Need to be healthy to return to work Sept. 2007. Choosing the Lap-BAND . Hopefully if i get approved i can get and return to work feeling well enought t o be there. Has any one else in NY had this problem with them .?I need hope feel like time is not on my side.

i have them.. you a teacher? (i am) well..............4 yrs ago they denied me for the supervised weight loss. back then they wanted TWO 6 month programs, not just one. i just had my 2nd surgical consult today and was given my date of august 20th..cutting it sooo close to go back to work on time. anyway... my BMI is 44, i have impaired glucose tolerance and sleep apnea. i did the 6 month medically supervised weight loss.. and i am hoping and praying they approve me. what were there reasons for denying you? i am very interested to hear your story ~Lisa

Lisa,  Yes Im a teacher too. they denied me first because progress notes from my NUTRITIONIST didn't do them exactly right. They were faxed over  correctly and right before the 15 th day i recieved that they wanted more inf from my PCP. Might have to go to an external appeal and then I'll have to wait for surgery till December. I hope the PCP hurries and sends the clearance letter then they have another 15 days to make a decision. Hopefully he will send it tomorrow. They ( GHI/CBP) are known for making it hard. Oh well I'll let you know how it goes. KAREN

I believe it is the NYC Healthline that approves or denies you, not directly GHI?  Your hospital coverage is approved through your Empire, but GHI follows NYC Healthline's approval or denial.  I could be wrong, but I believe that is how it goes. 

Molly  Thanks for the info .I believe you are correct. That's why all dr's get nervous when they see the NYC heathline. But you are correct about hospital being covered through empire. Like I said I really do not know that much about it . I have never been a paper work person. I am surprised thst my surgeons office let the papers go out with out making sure everything was correct at the beginning. Thought they knew what was needed. They didn't even fax cardio and endo clearance. OMG What will be /will be Let that be a lesson to all . If you want it done right do it your self. Or check everything out.. KNOW YOUR INSURANCE COMPANY Karen