Empire Plan denial - 6 wks from surgery HELP!!!

TyRah
on 8/8/08 9:03 am - Upstate NY, NY
Hi everyone.  I've already gone through most of my testing through Ellis and got a call today that Empire BC/BS is denying my surgery.  I'm scheduled for September 23, 2008.  They said that they needed 6 months on a weight loss program.  I did Weigh****chers at work and in 18 weeks gained 2 pounds.  (Why would I pay to gain weight?)  I also went to LA Weight Loss for 2 years and now they have closed and there is no information available for them so I can't get documentation from them.  Any advice?  Anyone else run into problems with the Empire Plan?  I'm disgusted and don't want to give up, but I'm at a loss.  I'd appreciate any help.
Thank you.
(deactivated member)
on 8/8/08 11:46 am - North of NYC
Double check on the "weight loss program" part of that sentence.  I was required to be on a medically supervised diet for Aetna.  However... if I went through my primary care physician it had to be for 6 months.  If it was through my bariatric surgeons' office then it only needed to be 3 months.  And they go by the number of visits, not the actual months.  I have my first appt this monday, then one scheduled for Sept, one in the beginning of Oct and they said I would be cleared for the middle of October.  That's really only 2 months supervised, but I'm not questioning it.

Good luck
sunshineluvskids
on 8/8/08 12:25 pm - NY
First of all.. good luck with whatever you choose to do.
I went through Albany Med, but I have the same insurance as you. I called before I started the WLS prep and asked the insurance company what they require. They told me the same thing that you have to get a doctor/nutrition doctor to help you/sign off on your weigh in's for 6 months. I also found out I have sleep apnea.. so that helped me get approved the first time.
It will help you a lot in my opinion to get help from a doctor for 6 months and lose 10% and get used to eating less before the surgery.
I am 3 weeks out after surgery.. and hardly eating is not easy sometimes...
But it is worth it!
Good luck.. if you do have to postpone surgery.. 6 more months to be healthier your whole life...
Sounds worth it to me.

(deactivated member)
on 8/8/08 12:28 pm - Cincinnati, OH
Call the ATTNY Generals office
That has worked for other people
TyRah
on 8/8/08 9:28 pm - Upstate NY, NY
Thank you everyone, please keep the advise coming.  ...  I'm just upset.  I finally got there mentally and am ready and now a road block.  Thank you.
kebbier
on 8/10/08 9:37 am - Saratoga Springs, NY
i will tell you this a hundred times over. IT IS ONLY A ROAD BLOCK AND A FEW MONTHS IS A SMALL PRICE TO PAY FOR A HEALTHIER YOU FOR THE REST OF YOUR LIFE.
you will get past this i promise,

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