Excellus BCBS NY

[angry 158]

So, I have been lurking around on these boards for a bit, but was forced out of hiding yesterday when for some reason out the blue I decided to call my insurance company to discuss coverage. I have excellusbcbs and they directed me to their online policy which can be found herehttps://www.excellus...57-09ef8ac1a985 (if you care that much). When I asked about the obvious contradictions ( I meet the initial criteria and may or may not have a co-morbidity as my blood pressure problem tends to disappear when I lose weight and I think it is resolved but havent been to the dr to verify) I was told to contact my surgeon. I dont have a surgery date yet, and my surgeon doesnt contact insurance until it is scheduled, and I dont want to wait that long because it is worrying me. I would like to have the vertical sleeve procedure. After lots of research it just seems to be the best fit to me, but I think it saying I can only have that surgery if I am super obese (bmi in excess of 50) No offense to anyone I have been super obese and I have no desire to be there again. I started at 331, but I am now down to 295 and I would prefer to have that downward trend continue. I am wondering if I have excluded myself from that procedure through this diligence at diet and exercise modification, cause that would really suck. I know that my surgeon to be prefers (or at least I have read he does) to do the gastric bypass and I am still a candidate for that surgery, but I dont want to have that one. Anyone else with experience in this area? Feedback is greatly appreciated.

[chinamama 104]

Ok I went and looked (gee I'm a geek). What I read is that you have to be over 50 bmi to have a duodenal switch (DS). The sleeve was formulated as the first step to that surgery, for those that were extremely obese it was often not safe enough to do the entire procedure at one time. They also found that many did not need the second step they lost all they needed with just the sleeve. The second half of the surgery is a malabsorbsion component.

Some people get pre approved for the DS, and in that way circumvent the one WLS per lifetime rule. They have the sleeve and then decide later if they need the second step or not.

[angry 158]

chinamama thanks so much for looking! Is that what they mean by staged procedure, that it is the initial surgery to be followed up by another later? I wasnt sure what that meant. So then I am interested in standalone sleeve gastrectomy (without any other later surgery) and that falls under the regular criteria of bmi over 40 and or 35 with comorbidities so I should be fine right? I hope that I am right about my interpretation of your response, because I am ecstatic! I super believe in signs and I was on the fence about the surgery, because I am scared of complications, I had been praying about it a lot and I decided that if I couldnt get the sleeve that was Gods way of telling me not to do it and if I could that was the green light. Thanks again.

[chinamama 104]

That's how I read it, but of course I could be wrong.

Good luck!!!

Laurie