BC/BS Excellus (Utica) EPO Balance

Hi I am from Illinois, but my husbands insurnace is through his employers parent company, located in New York. I was wondering if anyone here has/had used BCBS Excellus BlueEPO Balance? If you have, how long did it take for you to get approval? What hoops did you have to jump thru, if it took more than one request? My Dr. is sending out the request for Preapproval this week...and I kinda want to know what to expect. Thanks in advance Brandy

Ok, I just read in the history a page or so back, that BCBS is no longer covering the surgery after the 1st of the year. Oh my God...I am sick to my stomach...all of this work... Naturally, the person I need to talk to in NY (benefits admin) is out until after the first of the year...

Don't get to worked up over this. It isn't all bc/bs companies. Check with your policy and give them a call they will let you know what is needed. Most want, edg, psyc eval, med ness. bmi of 40 or higher, some want sonogram of ab, stress test, and sleep study. I had to have all plus extra bloodwork. Hang in there.

Thanks Tina. I've had all but a recent sleep study, the one I had was two years ago. Everything else has been done (EGD, EKG, Psych Eval, BMI of 54, Sono of Gall Blader and Chest Xray). I really hope that this doesn't affect me. When I talked to the Plans Admin two weeks ago, I asked her if the plan would be changing...and she said, "There will be no changes to the plan this year, only an increase in cost"...so I hope I'm covered...I tend to overreact...especially when I want something SO darn bad!

Brandy, I have Bc/Bs Excellus(Rochester) and was flipping out myself a few days ago over all the ins change rumors.I was approved earlier this month but still don't have a surgery date.I called Bc/Bs because I was concerned they wouldn't pay if I had the surgery next year The member service rep said that they will still be covering it next year but are narrowing the approval requirements.Sorry she didn't specify how.It wasn't hard to get approved in the first place I got my approval 14 days after my first consult and within 48 hours of my dr.'s submission.The ins required a 10 year weight loss history,a psych eval. and co-morbidities that caused this to be medically necessary.I hope this helps a little. So far the constant hoop jumping has been very hard but be patient the payoff looks great.

Thanks Ci, I wonder, are BCBS Utica and BCBS Rochester two different companies? They both carry the names Excellus...which makes me think yes...but they seem to have different requirments. I ask, because when my Dr.'s office called for the approval requirements, it didn't include 10 years of weight loss history, only a listing of past plans tried, the psych eval a BMI of 40+ and I think thats it...but I don't remember. I think the director is going to submit me tomorrow, and if she does, I'm hoping for pre-approval fast...that way I don't have to worry about the changes. Thanks again