Question:
Weight Loss Coverage

I was looking at the coverage page on the internet for my insurance, which is Empire, UHC PPO for new york state employees. It said that weight loss is covered if the person is morbidly obese and the services are performed in a physician's office. So, I am wondering if that means that the WLS would be covered?    — LaKeeva W. (posted on November 4, 2003)

November 4, 2003
I think it would be. It sounds like they are just making reference that they wont pay for things like gym memberships, weight watchers, LA weight loss, and those kinds of programs. Only way to know for sure is to call them directly. Check out the insurers section on ObesityHelp and it will show if anyone with Empire insurance has been approved as well.
   — ImANewDee

November 4, 2003
I don't have Empire, but I do have UHC, and my policy states coverage for wls at bmi over 40 or 35 with co-morbidities. I would say that if your policy covers in office weight loss services, then it probably does not exclude surgery, as most policies do not cover anything like that. Just call your ins. co customer service, tell them which policy you have, and ask if it's excluded if not and what the criteria for approval is. You don't even have to tell them your name if you don't want to. If they don't know, don't hang up without the number of the person who does know, or ask for their supervisor. If that doesn't work, human resources at work can provide you with a detailed copy of your policy. Good Luck!
   — Susan R.

November 4, 2003
i dont know if this helps but empire bcbs is my hubby and my insurance. in 2oo2, i was approved with no problem. about 3 weeks ago when my husband decided to have surgery too, i called empire and everything is still covered. you can get a case opened right now and get info from your case manager. just call the number on your card and contact the prior authorization dept. you will get a customer service rep first. tell them you want the case manager for your group. you will probably have to leave a voice mail message but they will call you back. my case manager has handled many wls cases and will tell you what you need. in our case, a psych eval and nutritional consult is required. also, the usual drs letter of medical neccesity. the point is you dont have to wait for the dr to do all the insurance stuff. you can get started on it yourself. email me if i can be of further help. good luck on your journey. patsy in las vegas
   — PATSY N.

November 5, 2003
I also have UHC PPO, I called the 800 number and asked for Care Coordinator and they told me what I needed and above all that is who gave me the Obesity help web site, I thank them daily. Patricia 9-30-03 314/272/190
   — pateblkbrn