Blue Cross New York Excellus covers weight loss surgery. To qualify for coverage of weight loss surgery, your individual policy must specifically include coverage. All policies may not include coverage. The details below pertain to those policies that include coverage.
Blue Cross New York Excellus Pre-Approval Requirements
Morbid obesity can be cured effectively by bariatric surgery. If you meet the requirements below, BCBS New York Excellus will cover the cost of your procedure, consultations and follow-up.
- At the time of applying, the patient has to be at least 18 years of age.
- The morbid obesity condition should have been diagnosed at least 5 years before the procedure.
- This means you must have proof (medical records typically from doctor visits) showing that your Body Mass Index has been over 35 for 5 years or more.
- For the patient to be covered in full for the surgical procedure, his/her BMI should be over 40.
- If the BMI is less than 40 and above 35, then the patient must be suffering from a co-morbid condition to receive coverage. Co-morbid conditions include:
- Coronary artery disease
- Type-2 diabetes
- Obstructive sleep apnea
- Hypertension (high blood pressure)
- Impaired glucose tolerance
- The patient has to submit a letter of support from his or her primary care physician. The documentation must state that the patient is suffering from morbid obesity and that previous attempts to reduce weight have failed.
- Six months of participation in a medically supervised weight loss program is required by the patient to be eligible for coverage.
- The obesity diagnosis and letter of support should be submitted by a physician other than the operating surgeon.
Types of Weight Loss Surgeries Covered By Blue Cross New York Excellus
Bariatric surgery procedures covered by Blue Cross New York Excellus include:
- Gastric Stapling
- Gastric Bypass Surgery
- Lap Band Surgery
- Biliopancreatic Bypass (This is only for patients with a BMI in excess of 60)
Blue Cross New York Excellus covers these procedures only if the patient meets all the requirements.
Procedures Excluded From Coverage
Bariatric surgery procedures that are not listed above would not be covered by Blue Cross New York Excellus. Detailed information regarding excluded surgeries can be obtained from their weight loss surgery policy.
Is A Second Weight Loss Surgery Covered If Lap Band Doesn’t Work?
A second weight loss surgery due to a lap band failure would not be covered because there are no guarantees that a second lap band would be effective. However, if Lap Band fails due to complications a revisional surgery from a band to gastric bypass or gastric sleeve may be covered.
Revisions
Revisions to bariatric procedures are subject to the following requirements:
- The post-surgery guidelines set by the surgeon were followed by the patient.
- Revision should be due to a technical failure of the procedure itself.
Does Blue Cross New York Excellus Require A Center Of Excellence?
There is no specific information available regarding Blue Cross New York Excellus’ requirement for a Center of Excellence. However, Blue Cross does have a list of hospitals that meet the requirements for their Blue Distinction certification and it may be required to have the surgery in one of these facilities.
Do I Have To Use An In-Network Bariatric Surgeon?
Generally an in-network bariatric surgeon is preferred. However, specific information was not found regarding this.
Blue Cross New York Excellus Contact Info to Inquire About Surgery
Call Blue Cross New York Excellus to inquire about weight loss surgery at 1-877-757-3850.
