Empire EPO?

I am trying to decide on insurance overage and one of the plans offered by my employer is Empire EPO.  The only information they could give me is that they cover all surgery that is "medically necessary"  Anyone have any experience with them?

I have Empire PPO BCBS and this is my policy statement from them:

Medically Necessary:

Gastric bypass and gastric restrictive procedures with a Roux-en-Y procedure up to 150 cm, laparoscopic adjustable gastric banding (for example the Lap-Band^® System or the REALIZE™ Adjustable Gastric Band), vertical banded gastroplasty, or biliopancreatic bypass with duodenal switch as a single surgery, is considered medically necessary for the treatment of clinically severe obesity for selected adults (18 years and older) who meet ALL the following criteria:

1. BMI of 40 or greater, or BMI of 35 or greater with co-morbid conditions including, but not limited to, life threatening cardio-pulmonary problems (severe sleep apnea, Pickwickian syndrome and obesity related cardiomyopathy),  diabetes mellitus, cardiovascular disease or hypertension; AND
2. The patient must have actively participated in non-surgical methods of weight reduction; these efforts must be fully appraised by the physician requesting authorization for surgery; AND
3. The physician requesting authorization for the surgery must confirm the following:
   • The patient's psychiatric profile is such that the patient is able to understand, tolerate and comply with all phases of care and is committed to long-term follow-up requirements; and
   • The patient's post-operative expectations have been addressed; and
   • The patient has undergone a preoperative medical consultation and is felt to be an acceptable surgical candidate; and
   • The patient has undergone a preoperative mental health assessment and is felt to be an acceptable candidate; and
   • The patient has received a thorough explanation of the risks, benefits, and uncertainties of the procedure; and
   • The patient's treatment plan includes pre- and post-operative dietary evaluations and nutritional counseling; and
   • The patient's treatment plan includes counseling regarding exercise, psychological issues and the availability of supportive resources when needed
      

Hope that helps :)  But again, that is my policy I would just contact them prior and see if you qualify. 

You can not rely on others that have Empire or insurance similar cause all policies are not the same.  I would suggest you call Empire and ask them specifically if this policy has WLS written in the contract or is it an exclusion