Empire Plan denial - 6 wks from surgery HELP!!!
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.
Thank you.
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
Good luck
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.
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.