Excellus BCBS of NY

[Luu2008 2]

For anyone with this insurance I would love to hear your experience with approval. Time line, any problems, successes, etc.

My BMI is currently 39. I went to orientation with a local bariatric surgeon and my first appointment is scheduled for next week. I have some potential comorbitities that I am worried are "weak" and so I'm trying to gain 5 pounds to push me into the morbidly obese category by next week. I was (shhhhh) told that this would help me by someone at the surgery orientation, won't ever tell who.

My real concern at this point is that my weight fluctuates considerably and sometimes I have seen Dr.s with low weights, as low as 160, however that lasts for 5 minutes and I'm back up in the obese category.

We'll see what happens. I plan on updating this thread with my insurance journey for those with same insurance carrier.

[Alfie 58]

I know this is trite but I think it would be loads of fun to be able to try to gain weight for once!! :thumbup:

My insurance experience went pretty smoothly; I did get denied one time but it was because there was a small detail in my paperwork missing. We got that cleared up and I was approved the next day. The surgeons office actually put through the paperwork and within just a couple of days, I got denied and then like I said was approved right after we sent in the revision. So altogether it was about a week. I have Aetna HMO and I live in New York.

Regards,

Alfie

[Luu2008 2]

Alfie,

Congrats on your recent surgery, you have lost so much weight already, wow!

Thanks for the info. on NY insurance experience. If you don't mind sharing what program are you in?

I don't want to admit this but, yes, it has been fun to try and gain weight. I'm planning on drinking a gallon of Water just prior to being weighed. I'm pathetic....but enthusiastic about getting the Lapband.

[Alfie 58]

Hey Luu,

Actually I have Aetna not BCBS. I lost the weight; 15 lbs in April, May 07, then 20 required by the surgeon (well he wanted 30 but got 20 :thumbup: ) Then the rest post op. I am struggling right now, as all swelling is down and I have no restriction. Due for a fill on March 7. Regards,

Alfie

[LiveLoveLaugh 0]

They don't weight you skin naked..... Put a couple rolls of coins in your pant pockets and bra...... Let me tell ya it works for you skinner BMI people...It did for a friend of mine...LOL We have to do what we have to do in order to get insurance providers to jump and pay for our needs. Why gain it all to only have to fight to get it back off again!! Just my .02

[Alfie 58]

hey LiveLoveLaugh, good thinking...sneaky but good LOL.

[LiveLoveLaugh 0]

LOL..... I'm all out for people and getting ewhat the insurance companies should do....... I think it's a load of crap when they nit pick at some for covering such a needed surgery. Please 1 point short of 40 BMI and they want to deny or challenge it.... Makes my blood boil at times..LOL

BUt really sick some rolls of QTRs in there it really does work...LOL

I just went throgh all my paper owrk on costs for my surgery and other pre-op testing etc.... It would have costed me $17,983.24 for my surgery. I ended up only paying a total of $135.00 which is my co-pays on all my appointment I went too........

[Alfie 58]

Hey Live, thats great, I wound up paying 150 for the co pay for my hospital stay..that was it. I believe my fills are covered as well! I hope!!:thumbup:

[LiveLoveLaugh 0]

That's awesome.... I'm covered for fills also. I do have to pay a $15.00 co-pay each time I go in.... Not bad if I say so myself!!! I can handle that payment........ I would be paying more for Weight Watchers...LOL, LOL, LOL I did Weight Watchers for years and lost 167 lbs. But ended up gaining it back twice...... The cost was close to $10. a week x 2 years that's close to $1,040.00 which in the long run was worth every penny for the weight I lost during that time..... Well here I am rampling a long..... I love my insurance it was an easy process when I got started, only took less than 4 months.... Yet again I'm a larger BMI than most out there asking for Lap-Band.......

[Luu2008 2]

Hmmmmmm I don't want to outright with rolls of coins even though it seems totally ridiculous that 5 pounds will keep me from insurance paying. But that got me to thinking...I'll wear my heavy coat, jeans, a few layers won't hurt, heavy wool sweater, and if a few coins (lets say our families entire coin jar) are left in my pockets....to ummm pay for my lunch. I can just see myself now rolling in, not able to bend my elbows and legs, jingling with change, looking like an overdressed for winter marshmellow. Do you think they might notice? :thumbup: Maybe I'll go with the rolls of coins.

[LiveLoveLaugh 0]

LOL......... Marshmellow, that reminds me of the old movie Ghost Busters......LOL, LOL, LOL I'm telling you it works and also your an inch shorter these days huh... Wow seems your shrinking a bit in your older age of 31...... LOL, LOL, LOL Flip that coin in your direction to make it happen... They ask how tall you are and they go by what you tell them you are............... All that swelling has gone down on the bottom of your feet these days.......... It was make sense!! (o:

[Luu2008 2]

Well bummer. My appointment for today, the first with the Bariatric program, was canceled and rescheduled for next Friday. I was hoping to start eating healthy today and begin my 5% weight loss that both my insurance and the Bariatric program require pre-surgery. At least it is only a week delay.

[donnaw725 0]

Wear your sneakers when you get weighed.There's 2 lbs right there.Some hiking boots give you 3 lbs.I called Excellus ahead of time and asked about coverage.As long as there is a medical necesity,HTN.Diabetes etc.Should not be a problem.I had my first visit with the doc in Dec.and i've been approved for the surgery as of last Monday.Good Luck

[jencys 2]

My doctor had me take off my shoes, empty my pockets etc. There was nothing but underwear and clothes on me. So wear heavy clothes just in case

[Luu2008 2]

I am officially obese enough for my insurance to cover me!!! I'm psyched. I have a million appointments in the next 2 months before everything is submitted to insurance. Its not over yet. I'll keep this updated with my approval and insurance process.