Excellus SimplyBlue Plus Silver 10 and in Upstate NY

[adashnau 22]

Does anyone else have this insurance? On my first visit, the nurse looked at the BMI listed from my primary care dr paperwork(41.9) and said that was all I really needed. I had printed out my paperwork that the insurance company sent me but I felt like I was reading a foreign language, the nurse didn't want to look at the paperwork, she said it wasn't needed because I had a BMI over 40 and some comorbidities. Today (3 weeks later) I went for my 2nd apt with the dietician and she said I've lost the 15 pounds needed and have done all the tests but she didn't sound very convincing that everything was in order. When I got home, I called and asked to the talk to the nurse who oversees everything. She said I've done a great job getting everything done and they are just waiting for my paperwork on psych eval, I did that 1.5 weeks ago. Then she asked if I had an insurance policy that makes me wait 6 months. I said I wasn't sure, that I had asked at first apt for someone to go through the insurance lingo with me. She wasn't helpful. So I still don't know if I need to wait 6 months even though all of my steps are complete once I go to the last required support group meeting tonight.

If you have this insurance, what has your experience been?

[applejenn 173]

I have excellus but blue point 2 value. Western ny. I had 4 nutritionist appt psych evaluation and support letter from primary, some insurance do have a wait period and more requirements

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[2goldengirl 2,076]

Excellus Medical Policy.pdf Here is a copy of Excellus medical policy. You have to show documentation of obesity X 5 years and show:

History of rigorous attempts at weight reduction.

1. There must be written evidence of a weight loss history, either by the bariatric surgeon, primary care physician or nutritionist. This documentation should include the name of the weight loss program, length of participation in the program and any weight loss achieved. At least one program must have been a supervised weight loss program;

2. Weight loss attempts need not be continuous, but a minimum total of six months is required.

a. If the patient has had no previous attempts at medical weight loss, participation for a minimum of six months in a preoperative bariatric surgery weight loss program is required.

b. If past prior attempts of weight loss are remote (greater than 5 years), then the patient is required to participate, for a minimum of six months in a preoperative bariatric surgery weight loss program

I hope this helps.