Does Excellus Blue Cross Blue Shield Cover Bariatric Surgery?
Does Excellus Blue Cross Blue Shield Cover Bariatric Surgery? Bariatric surgery is often considered a necessary step for individuals with severe obesity who have been unable to achieve significant weight loss through diet and exercise alone. The procedure can improve many obesity-related health conditions such as heart disease, high blood pressure, sleep apnea, and certain types of diabetes. However, the cost of this life-changing surgery can be a significant hurdle for many.
Excellus Blue Cross Blue Shield is one of the insurance providers that potential patients turn to for help in covering the cost of bariatric surgery. It’s important to understand what coverage options are available under this provider. This article aims to shed light on whether Excellus Blue Cross Blue Shield offers coverage for bariatric surgery and what criteria they may require for eligibility.
Coverage for Bariatric Surgery
Excellus Blue Cross Blue Shield is a well-regarded health insurance provider recognized for its comprehensive coverage options. One of the critical areas where Excellus Blue Cross Blue Shield provides coverage is bariatric surgery. This coverage is significant, as bariatric surgery can be quite costly and may be out of reach for many individuals without insurance support.
The amount of coverage Excellus Blue Cross Blue Shield offers for bariatric surgery varies depending on the specific plan chosen by the individual or offered through their employer. Some plans may cover a large percentage of the surgery’s cost, while others might require more out-of-pocket expenses from the patient. It’s essential to review your specific plan details to understand what portion of the surgery costs will be covered.
Another important factor to consider in terms of Excellus Blue Cross Blue Shield’s coverage for bariatric surgery is the type of procedure being performed. There are various types of bariatric surgeries – gastric bypass, sleeve gastrectomy, adjustable gastric banding, etc. Not all procedures may be covered under every plan. Therefore, it’s crucial to consult with Excellus Blue Cross Blue Shield or a trusted healthcare provider to determine which procedures are covered under your specific plan.
It’s also worth noting that while Excellus Blue Cross Blue Shield does provide coverage for bariatric surgery, it likely requires prior authorization for this procedure. This means that before undergoing surgery, you or your healthcare provider must first get approval from Excellus Blue Cross Blue Shield. This process usually involves providing detailed medical records and demonstrating that the surgery is medically necessary.
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Eligibility Criteria
When considering bariatric surgery under Excellus Blue Cross Blue Shield coverage, it is essential to understand the eligibility criteria. The insurance provider typically requires certain conditions to be met before they authorize and cover the procedure. These criteria help ensure that the surgery is medically necessary and has a high likelihood of improving the patient’s health outcomes.
The first criterion often concerns the patient’s Body Mass Index (BMI). Excellus Blue Cross Blue Shield generally looks for patients with a BMI of 40 or higher, signifying severe obesity, or a BMI of 35 or higher if
the individual also has an obesity-related condition such as diabetes, heart disease, or sleep apnea. This is in line with the National Institute of Health guidelines on who should be considered for bariatric surgery.
Secondly, Excellus Blue Cross Blue Shield typically requires proof that the patient has tried and failed to lose weight through non-surgical means. This usually includes participation in a medically supervised weight loss program for a specific period. The exact length of time can vary depending on the individual’s specific plan, but it’s often several months to a year. This requirement ensures that surgery is only considered when less invasive methods have not been effective.
Additionally, some plans may require psychological evaluation before approval for bariatric surgery. This is because the success of bariatric surgery is not just about physical health but also mental readiness. Undergoing bariatric surgery can entail significant lifestyle changes post-surgery, and patients must be mentally prepared for this.
In conclusion, while Excellus Blue Cross Blue Shield does provide coverage for bariatric surgery, there are specific eligibility criteria that prospective patients must meet. These include a qualifying BMI, evidence of unsuccessful non-surgical weight loss attempts, and possibly a psychological evaluation. It’s crucial to consult with Excellus Blue Cross Blue Shield directly to understand these eligibility requirements fully.
Frequently Asked Questions
Does Excellus Blue Cross Blue Shield cover all types of bariatric surgery?
Excellus Blue Cross Blue Shield provides coverage for various types of bariatric surgery; however, the coverage may vary depending on the specific plan. It is essential to review your plan details or consult with Excellus Blue Cross Blue Shield to determine which procedures are covered under your particular plan.
How do I know if I'm eligible for bariatric surgery coverage under Excellus Blue Cross Blue Shield?
Eligibility for bariatric surgery coverage under Excellus Blue Cross Blue Shield typically depends on factors such as Body Mass Index (BMI), documented attempts at non-surgical weight loss, and potentially a psychological evaluation. It's recommended to review the eligibility criteria outlined in your specific plan or contact Excellus Blue Cross Blue Shield directly for detailed information.
Yes, prior authorization is generally required before undergoing bariatric surgery with coverage from Excellus Blue Cross Blue Shield. This means you or your healthcare provider must obtain approval from the insurance provider by submitting relevant medical records and demonstrating that the surgery is medically necessary.
Will Excellus Blue Cross Blue Shield cover the entire cost of bariatric surgery?
The extent of coverage for bariatric surgery under Excellus Blue Cross Blue Shield varies depending on the specific plan. Some plans may cover a significant portion of the procedure cost, while others require more out-of-pocket expenses from the patient. It is advisable to review your plan details or consult with Excellus Blue Cross Blue Shield to understand the financial implications of the surgery.
Can I choose any bariatric surgeon if I have coverage through Excellus Blue Cross Blue Shield?
While Excellus Blue Cross Blue Shield provides coverage for bariatric surgery, they may have a network of preferred providers. It's important to check if your chosen surgeon is within the network to ensure maximum coverage. If you opt for an out-of-network provider, your coverage may be limited, resulting in higher out-of- pocket costs.
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