Blue Cross/Blue Shield of Empire

Hi, Has anyone out there have BCBS of Empire (NY) ? I would love to hear how quickly or slowly you were able to get approved. I found out today that they have "no criteria" to be approved, just as long as it is medically nessasary. They are telling me that now after all my paperwork was submitted, that they need a medically supervised 6-month diet (of which I already had 3 months) I'm glad I did. Now they say that although they don't claim to have a criteria, I need to have my MD prescribe DIET PILLS! they want the next 3 months for me to be on drugs! because afterall, if I loose weight with the diet pills, isn't that better than to have such a drastic thing done to my body like "the gastric Bypass'? Am I loosing it?

PILLS???????? That's the worst. I am going through something similar with my PCP -- he thinks that if I lose weight before surgery that shows I don't need the surgery after all. I keep telling him that is the trick my body has played since I was 9 years old! If I could lose it all, I already would have done it. SHeryl

Virginia, Did you call the pre-certification number on the back of your card to see what they require? Just calling your 800 number doesn't work. I have BC/BS Fed. and that is what I finally had to do. Another suggestion is that you do weigh****chers or something like that with the support of your doctor. Another thing that you can do is go to the doctor once a month and get weighed and talk about weigh loss. I took the pills and guess what lost 15 lbs. and gained back 30, so they just want you to jump thru hoops. Keep doing what you have to do, the surgery is the greatest thing that I did for ME! Clara

Just an FYI that Weigh****chers does not qualify as a "dr supervised" weight loss program. But if you do that in CONJUNCTION with weighing in with your dr ONCE a month and DISCUSSING the WW diet plan then that counts. As long as you and your dr discuss diet and exercise and weigh you once a month that counts. Trisha

Hi, thanks for your responses. Yes, I am willing to do whatever they want me to do to get this surgery. If they want me to stand on my head (as hard as that would be for me) for 20 minutes a day and then write a paragraph about how it makes me feel...I'll do it! I know that sounds rediculous...but so does diet pills!!! I wonder if the insurance co. will be willing to pay for my heart problems due to the "medically supervised speed!" I am sorry for venting. I guess the ins. co. must be made up of very thin people that have no idea what it is like for people like us to get the healthcare we need and deserve. They want people like us to just forget about this wonderful tool,(WLS) and just go away.

Even if you lose on the pills or a dr's diet plan, they'll still approve you for surgery. I worried the same thing pre-op when I was going through my "6 month dr supervised diet plan". Most insurance plans don't even cover diet pills- mine didn't. And remember, you can go ahead and get the pills, but doesn't mean you HAVE to take them! Seriously. Insurance companies want you to jump through so many hoops. Do what you can, but don't stress over it. Lose some weight if you can, but not too much, if you know what I mean. And diet pills are only good for as long as you take them. As soon as you stop taking them the wieght comes back on. The surgery on the other hand is permanent, and it's a tool to help you lose. Not a crutch. Pills are a crutch. Think of it that way. You'll be okay and you'll be approved. Keep us posted.! Trisha