GHI/Emblem

Kimmeroo
on 6/10/10 10:35 pm

Hi everyone!
I was wondering how to get the list of exclusions and rules for my insurance coverage? i have had the insurance for 11 months and have called and ask someone to send it to me but no one ever has.I have been to their website numerous times and cannot figure out where to look about wls.If anyone can help me I would appreciate it.TY in advance!:)

Kim

Kim
____________________________________________________
HW 264/CW 148/ GW 160(doc) 175(me) 2014..HW 264/Cw 156/ Maintain
Finally made it to Dr.'s Goal..yay! (9/17/11)
Hit my own goal! Yay!
Hit Onderland 1-11-11...my anniversary!:)
Lost 116lbs total since my journey began

dolphinlover32
on 6/11/10 12:55 am - Denmark, NY

RNY on 04/19/10 with

Hi Kim:) I had GHI as well and they covered mine but I needed the 6 month supervised diet done and a psych eval done and nutrition eval done and bloodwork done and my pre op done that's really about all I was surprised they didn't make me go see a cardiologist but they didn't I guess it all depends on what your problems are before hand....The only thing I had was being overweight and had acid reflux and joint pain quite often!! So Good Luck with it:) I would call and tell someone u called 11 months ago and never got the info and request it be sent to you!!~Lisa

Kimmeroo
on 6/11/10 12:30 pm

RNY on 09/14/10 with

Thanks Lisa..wow what a small world! i have had a hard time finding someone who has GHI...did they tell you what wls were covered? I am just curious...I had called early on about the DS and they said no they don't cover it and then I got the code for the VSG and they told me that that number didn't exist...????So here I am going for the RNY..lol

It is very encouraging that they covered you!:)Thanks again Lisa!:)

Kim

Kim
____________________________________________________
HW 264/CW 148/ GW 160(doc) 175(me) 2014..HW 264/Cw 156/ Maintain
Finally made it to Dr.'s Goal..yay! (9/17/11)
Hit my own goal! Yay!
Hit Onderland 1-11-11...my anniversary!:)
Lost 116lbs total since my journey began

dolphinlover32
on 6/11/10 1:16 pm - Denmark, NY

RNY on 04/19/10 with

Hi Kim as far as I know and understand the only one they would cover was the RNY whether it be laprascopic or open, I once was told they wouldn't cover anything else....I hope u get a definite answer on what your looking for!! Your very welcome and 1 month to go for the supervised diet and u can move forward I can't wait to hear all about the journey life will take u:) Take Care and ttys ~Lisa

(deactivated member)
on 8/12/10 1:36 pm

Hello, I am new to the forum but I too have Emblem Health (GHI), I was told the same things for pre-surgery as far as BMI counts, nutrition classes etc however my concern is that I am told insurance will cover all three procedures RNY, VGS, and LB. Has anyone tried this? I keep reviewing and reviewing and I think VGS may be a great option for me so if I can't I'd rather know with certainty.

As for checking with the direct I went to Emblemhealth.com and searched bariatric surgery and the list of requirements did come up.

Tnx for the help:)

AndreaH09
on 6/11/10 10:30 am

RNY on 08/05/10

You have State Health Benefit Plan?
If so, I can tell you that I called UHC to get the "summary plan description" for FY 2010 and they said the Ga Dept of Community Health is supposed to issue it. If you go to Ga Dept of Comm Health - SHBP website, it only has the 2009 summary plan description posted (the last time I looked). I tried calling SHBP and there is a constant recording on there that they "are busy, try again later". Very frustrating!!!

AndreaH09
on 6/11/10 10:31 am

RNY on 08/05/10

Sorry Kim - - - I thought I was still on the "Georgia" forum page. My previous answer probably does not apply to you.
I hope you find the info you need.

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