Question:
Is there anytype of wait once you have insurance?

I recently got married. My husband has insurance, but I will not be able to join in on his insurance till Oct. He has Empire Blue Cross Blue Sheild. I am axious to know is there a waiting period or a claus with this insurance of a wait period or denials for a pre-existing condition such as morbid obesity? How hard is it to get them to ok the surgery?? Anybody out there know?    — earth-angelsc (posted on May 21, 2007)

May 21, 2007
You might want to start with a diet supervised by your physician... most insurance companies want a 6 month diet history. So that will be something to get started on now if you can. GOOD LUCK Susan
   — sallyone

May 21, 2007
it depends on your dr. and how fast they push it threw me. i had a consultation dec 5,2006 and i was given my surgery dat for feb 1,2007. just 7 weeks for me i guess i expedite matter by being prepared . fast because i brought in my medical record . from previous dr. that i vist for weightloss. so i got aprove instantly. i have amerithealth. good luck.
   — yvettetas

May 21, 2007
I can't answer your question and probably no one can at this point as even with the same insurance company, the plans can differ from employer to employer. It all depends upon which plan your husband's firm went with. You can get some answers from his benefits office. There are 2 really good books that have chapters devoted to getting approved and appealing denials... they are as follows The Doctor's Guide to Weight Loss Surgery and Gastric Bypass Surgery. I refer to the first one all of the time in answering questions here and for reviewing for myself. Good luck to you.. As the other poster said.. start getting your weight loss attempts documented. If you have done some in thepast see if you can return to those centers and get the records from when you went. Then start a program now.. you can try any of them out there, just make sure that you are seeing your physician periodically so that they can document your weight and what you are trying whether it be a formal program like Weight Watchers, Jenny Craig, LA Wt Loss or just dieting and exercising using low carb high protein diet.
   — Kari_K

May 21, 2007
I agree that you need to get on a weight loss plan asap & see your pcp right away. My husband's BCBS of IL required 1 yr, though I think 6 mo is most common. I did Jenny Craig. The Ins Co had an approved list of plans. The big secret for me, was in seeing the Dr. Every time I went, once a month, the FIRST thing I was there for was Weight management. The Dr wrote that on the notes FIRST & Coded that FIRST on every visit, regardless of what else we needed to talk about (be that my cold or my medication, etc). The second big assist for me, was getting a copy of the pages of the contract from customer service, that had to do with the surgery. Good luck. God Bless. If you have problems with the ins, send me an email. Mickie
   — asinmouse

May 22, 2007
Hi Sheryl. You have to contact his insurance carrier and ask. Insurance companies have tons of different policys. If they do cover it, they may have obligations to meet to get the benefit. His company may have chosen a plan that does not cover wls. Even if the company does cover wls, your husbands work may have chosen a policy that excludes it. Contact Empire and ask your questions there. They will be honest with you, and will know everything eventually anyway when you come on board. You can't hide that you are obese now, it will be known. It may or may not be considered pre-existing. Since obesity is not considered a "condition" unless you are on disability (I think), I don't know if it is a pre existing anything. Ask them about how long it takes to get approval and their requirements. You should have a good relationship with them when you get on board anyway, so ask. Your husband may have to call and ask, or sign a document to let you have access to information, but do what you need to and get real answers, not guesses from here. We can only guess for you, but you can know by calling. Take care. Patricia P
   — Patricia P

May 23, 2007
My husband and I have Empire BCBS through the hospital that he works for. They have a waiting period of 6 months from the time you speak with the surgeon (and he bills them for it) until you can schedule your surgery. Also, the nutritionist and the psychologist are not covered for their appointment to write you a clearance letter (both were $250 for me). Just call the number on the back of your card and they will explain everything to you, that's what I did. I agree with the other posters though, everything depends on the employer that is offering the insurance, there are alot of variables with the plans. Good Luck!
   — PurplePixie