Does anyone have Empire BC/BS PPO and ............

Happy Friday everyone!! Does anyone have Empire BC/BS PPO and has had to go through SHPS to get approved? I had to send everything into SHPS and they said the case manager (a nurse) would look over my case and usually have a decision made within 48 hours. I was wandering if anyone else has gone this route and if so....how long did it take you to get your approval after you sent everything off? Thanks for anything you can add to this.....I'm so excited....and the waiting is killing me! My poor hubby, I know, is sick to death of talking about this....but I just can't keep my mind off of it. So, any advice would be appreciatted Thanks a bunch, Mia

I have BCBS PPO but I don't know what you are referring to when you say SHPS. I also had a case manager and was approved the day it was submitted.

Wow....that was quick! What all did you have to send in when you sent your stuff off for insurance?  Oh, and SHPS is a manage care provider for our insurance through our work. Thanks for sharing, Mia

Mia, I have Empire BC/BS PPO but a different "Case-Managment" group than SHPS. My WLS and PS were both covered completely. Have no idea if you situation is similar. Best Wishes- Dx

Wow! Wouldn't that be ideal!  Thanks for the well wishes, Mia

Hi.  I have Empire (NY) BCBS PPO, but I'm not familiar with "SHPS." My surgeon's office submitted my paperwork, and then were notified that I needed a better letter from my PCP.  Once I got that to them, it took about a week to get my final determination - APPROVAL! I called them daily once I knew they had everything they needed, and my case manager ended up calling me personally to let me know that I had been approved! If you have any other questions, please don't hesitate to contact me. Empire BCBS PPO was awesome for me... they covered almost everything - I had very little out of pocket costs.

Thank you Sounds like everyone has been pretty lucky. So far it seems that Empire BC/BS has been fairly quick with their approval's....let's just hope mine will come as quickly. What kind of letter did they require from your PCP?  They sent me a pre-approval letter stating that the RNY was covered in my plan and they would pay 90% if I meet criteria and I'm approved...that's music to my ears......now I'm just waiting for approval! Thanks, Mia

The initial letter that I had from my PCP pretty much stated that she would support my finding out about having the gastric bypass. The insurance wanted more than that from her, so I found a form of letter for her that basically listed my medical history as far as my high blood pressure and weight history (I didn't have any other co-morbidities) and my dieting history and said that she supports my having the surgery. Once they got her letter, it took maybe 2 days for them to approve me. Good luck! Wendy

Hi , Yes, I have BC/BS PPO and had to go through SHPS.  It took about 3 days.  And they were so nice.  I kept calling them to find out about approval because I was so excited.  After my surgery was complete, I only had to pay about 250 dollars out of pocket.  They approved everything else.  Now, don't freak if they only approve you for 1 day in the hospital.  My doctor says they do that, then the doctor notifies the insurance company that the patient need extra time in the hospital.  Don't think you will have to pay for the extra days yourself. Hope this helps.  Did you know that SHPS will pay for your diabetic supplies if you need them per your doctor?  They send me all my test strips and lancets free.... Good luck...if you need anything just ask. P

Sounds great! No, I didn't know that....I'll have to check into it.  Do you remember all of the things they made you submit for approval? I am trying to make sure I dot all of my i's and cross all of my t's so to speak.  Thanks for the help, Mia