Empire Blue Cross Blue Shield PPO

CynthiaMcC · 12-28-2007, 07:01 PM

Hi -- Just thought I would see if anyone has had experience with Empire Blue Cross Blue Shield PPO? I am located in Missouri. According to their requirements, I should qualify, but am just curious about any positive or negative experiences. Thanks. Cynthia

kaninag · 12-28-2007, 07:30 PM

Can you tell me what their requirements are? I just filed for the surgery with BCBS PPO but my insurance changes to Empire BCBS PPO jan 1 and i was told i would have to refile....just wondering how strict they were....

CynthiaMcC · 12-29-2007, 09:37 AM

Sure ...

BMI of 40 + or 35 with co-morbid conditions
Patient must have actively participated in weight loss efforts and physician must be apprised of them
Physician must confirm the following
Patient's psych profile is able to understand, tolerate, and comply with all phases of care and long term follow up
patient's post op expectations have been addressed
patient has preop medical consultant and is ok for surgery
patient has undergone preop psych consult
patient has received through explanation of risks, benefits
patient's treatment includes pre op and post op dietary eval and nutritional consulting
treatment plan includes counseling regarding exercise,psych issues, and availability of supportive materials

In reality, this meant a preop visit to an RD, psychologist, and complete physical. According to my doctor's office, Empire usually is not too bad. Our company allows for a choice of providers, so we decided they would be the best option from an insurance requirement perspective. I also switch 1/1 so we will submit everything on the 2nd. Good luck!

pippinje · 12-29-2007, 04:14 PM

I changed my coverage from an HMO to Empire BCBS effective for 01-01-08 just for the sole purpose of this surgery being covered. I am super siked that 01-01-08 is almost here so I can finish getting everything needed. My dr. office also said they are great to work with. According to my dr you need letter from dr showing why surgery is med. nec., nutriotional counseling, pysch evaluation.

I have already had my nutritional counseling (paid out of pocket) but the psych eval was so pricey I had to wait until coverage begins. I am calling 01-02-07 to get pre-cert for the psych eval. I am scheduled for eval on 01-08-07. Once completed, all paperwork can be turned in to BCBS for approval!!!!

I AM SO LOOKING FORWARD TO THE NEW YEAR!

jst4kel · 12-29-2007, 04:33 PM

I have the same insurance and I had to see a dietician, have a psych evaluation, and the surgeons consult before being approved. My plan pays 100% after $2000. It was all pretty much a piece of cake. The insurance required the psych evaluation, but wouldn't pay for it. It cost me $295. Good Luck! My approval took less than 3 weeks after I completed all the requirements, part of that was the slowness of the transcription from my surgeons consult.

pippinje · 12-29-2007, 06:04 PM

Well the good thing about the pysch eval for me is that effective 01-01-08 my policy is no longer using Magellen for it's behavioral health, it will begin using Anthem Behavioral and I have heard alot better things about them.

CynthiaMcC · 01-09-2008, 06:31 PM

Just a note to say that I received my approval today from Empire. It was amazingly fast. My policy began 1/1 so we had to wait until it was loaded into the system before submitting the paperwork, that happened yesterday, got approval today. Surgery is scheduled for 1/31.

kaninag · 01-09-2008, 06:36 PM

OH I AM SOO JEALOUS!!!!!!!!!!!!!!!!!
CONGRATS THOUGH!!!!!!!!!!!!!!!!!!!1
Listen I am waiting still I submitted all my info...well 1/5 but they said they didnt receive it until this tuesday...but thats ok.....you give me hope due to your quick approval!!!!! WE MAY BE HAVING SURGERY THE SAME DAY LOL
Listen can I be a little personal...if you dont mind what was your bmi and did you have any comorbidities????

CONGRATS!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!:whoo::clap2::clap 2::clap2::clap2::clap2::D:D

CynthiaMcC · 01-09-2008, 06:39 PM

No co-morbities, but my BMI is 42. Thanks. I hope yours is just as fast!

kaninag · 01-09-2008, 07:26 PM

Thanks bunches...that really makes me feel better has your BMI been greater than 40 for the last 3 years? Thats what BCBS requirement was but with Empire thats not listed on their requirement list:)

kaninag · 01-09-2008, 07:26 PM

*cant you tell I am really nervous about getting a denial;)

pippinje · 01-09-2008, 08:20 PM

Wow Awesome. I am seeing green too! I have completed everything they require. Just waiting on the psyc report to be sent to my pcp so everything can be submitted. He said it would be ready by 01-15-08 but I think I will start bugging them since you said it was quick for you.;)

CynthiaMcC · 01-09-2008, 09:43 PM

They did not ask for any weight history, and quite frankly, I do not know exactly what is has been. I am at my highest ever, but only a difference of 20 to 40 pounds over the last 3 years.

CynthiaMcC · 01-09-2008, 09:47 PM

I am really surprised by the approval and speed. I was preparing to self pay, and in talking with the doctor's office decided to try when my insurance changed on 1/1 ... am very glad I waited.

kaninag · 01-11-2008, 07:05 AM

I got to thinking....the only thing i havent done is the psych eval.....my doctor waived it,.....does this mean the insurance company will too????