Does Blue Cross Blue Shield Cover Weight Loss Surgery?

Millions of people across the United States benefit from Blue Cross Blue Shield (BCBS) health insurance plans. If you are considering a weight loss surgery to eliminate obesity, you should review the terms and conditions of your BCBS medical policy to determine your coverage. Upon submission of the necessary documents that confirm your eligibility, you can obtain pre-approval from your insurer for your Blue Cross Blue Shield bariatric surgery coverage.

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Blue cross blue shield bariatric surgery

People who are struggling with obesity often wonder: Does Blue Cross Blue Shield cover weight loss surgery? The answer is yes, subject to fulfillment of the specific eligibility criteria set by your insurance provider. Bariatric surgery is recognized as an effective way to get rid of obesity and associated co-morbidities. As long as it can be shown that your procedure is a medical necessity, you can receive Blue Cross Blue Shield bariatric surgery coverage.

Types of weight loss surgery covered under BCBS

The Blue Cross Blue Shield weight loss surgery program offers coverage for a number of bariatric procedures. Gastric sleeve and gastric bypass are two of the leading procedures that are considered the safest and most definitive solutions to morbid obesity. The insurance companies in all the states cover these two procedures under Blue Cross Blue Shield bariatric surgery plans. In some cases, adjustable gastric band surgery (lap band) is also covered.

Can a BCBS plan exclude bariatric surgery coverage?

Yes, some Blue Cross Blue Shield plans may not cover bariatric surgery. This will depend on the type of policy you have purchased. However, an exclusion of weight loss surgery from your BCBS plan should not discourage you from exploring various low cost self-pay options. Many patients who have inadequate or no insurance coverage for weight loss surgery now seek safe and affordable offshore medical tourism options.

Does blue cross blue shield cover bariatric surgery?

Yes, Blue Cross Blue Shield covers bariatric surgery, subject to the type of insurance policy you have chosen. It’s vital to note, however, that even when you are paying the premiums for it, you will receive actual coverage only if you complete the necessary documentation for approval.

  • Policy exclusions: If you want to know does Blue Cross Blue Shield cover bariatric surgery, and are there any exclusions in your plan, call your insurer or talk to your employer. Review the exclusions section in your health policy to know whether weight loss surgery is a covered benefit or not.
  • Types of coverage: If your Blue Cross Blue Shield covers bariatric surgery, it is still important to know what types of weight loss procedures and obesity treatments are covered under your plan. The coverage amount can vary depending on your type of policy and benefits you have chosen.
  • Out-of-pocket costs: Even when your Blue Cross Blue Shield covers bariatric surgery, your individual health plan may have co-pays, deductibles, and maximums for out-of-pocket expenses. These limits are reset each calendar year, so talk to your insurer ahead of time for more clarity.

RelatedFinancing weight loss surgery: Bariatric financing options

Does blue cross blue shield cover gastric sleeve?

Blue Cross Blue Shield gastric sleeve is a covered procedure under many types of insurance plans for qualified individuals. Gastric sleeve is currently the most popular form of bariatric surgery with an excellent success rate. Therefore, as long as you meet the eligibility conditions, you should be able to obtain approval from your insurance company without much difficulty.

  • Coverage can vary: Each Blue Cross and Blue Shield health plan can vary regarding which gastric sleeve surgery expenses are covered. Talk to your insurance agent to verify the available coverage for you by filling out the free, no-obligation verification form. This will give you clarity on actual amount of coverage.
  • Meet the conditions: The process to obtain Blue Cross Blue Shield gastric sleeve coverage will include determining whether your body mass index falls within the required range. The insurer may also require details of your non-surgical weight loss efforts and your psychiatric evaluation report.
  • Risk awareness: Insurance providers in many states will require your bariatric surgeon requesting Blue Cross Blue Shield gastric sleeve coverage to explain to you the risks and benefits involved. They may also have to conduct a dietary assessment and provide you nutrition counseling.

RelatedHow much does gastric sleeve cost?

Does anthem blue cross blue shield cover gastric bypass

Yes, Anthem Blue Cross Blue Shield covers gastric bypass surgery, provided your health plan does not particularly exclude this procedure. The nationwide Anthem BCBS network recognizes obesity as a serious illness and offers some form of gastric bypass coverage under most of its health plans. Here are some of the key issues to keep in mind for your coverage.

  • Check whether your employer has opted-in for Anthem Blue Cross Blue Shield gastric bypass coverage.
  • If you have an individual policy, check the gastric bypass pre-approval requirements for your Anthem Blue Cross Blue Shield.
  • Consultation and recommendation from a qualified weight loss surgeon may be a mandatory requirement for pre-approval.
  • Both traditional gastric bypass (open surgery) and laparoscopic Roux-en-Y gastric bypass procedures are usually covered in Anthem BCBS.
  • Does Anthem Blue Cross Blue Shield cover mini gastric bypass? The answer is no, because this procedure is considered experimental.
  • Anthem BCBS gastric bypass should be performed at a bariatric center of excellence, but not necessarily by an in-network surgeon.

Related: Reasons to be denied weight loss surgery

Does anthem blue cross cover lap band surgery

Yes, Anthem Blue Cross covers lap band surgery provided you fulfill the eligibility criteria for this weight loss procedure. Make sure to carefully go through your insurance policy document to know which expenses related to your lap band surgery are covered. It’s always a wise idea to call your insurer and ask them to verify your actual Anthem Blue Cross lap band surgery coverage for you.

  • Lap band is a less frequent weight loss procedure, and Anthem Blue Cross lap band coverage may require a surgeon’s recommendation.
  • The pre-approval criteria and actual lap band coverage may vary for each patient and for each Anthem Blue Cross insurance plan.
  • Apart from meeting the BMI eligibility requirements, you may have to submit a letter detailing your weight loss efforts in the last 5 years.
  • Your co-morbidities will be evaluated if your BMI is less than 40 before you get Anthem Blue Cross lap band surgery authorization.
  • Depending on your lap band coverage, you may have to undergo up to one year of medically supervised non-surgical weight loss program.
  • Lap band fills cost is included in your Anthem Blue Cross lap band coverage, if your prior lap band surgery met the required conditions.

Related: Medical financing

How long does it take BCBS to approve bariatric surgery?

Blue Cross Blue Shield will take up to 30 days on average to approve your request for bariatric surgery. Therefore, when you are planning to undergo a weight loss surgery with insurance coverage, plan ahead of time, and keep track of the time it takes to complete the BCBS approval process.

  • Expedite the approval: To begin with, choose a hospital or bariatric surgeon that will help you meet the BCBS approval conditions quickly, and will follow up with them on your behalf. Prepare all the necessary documentation that BCBS may demand, such as health records, medical tests, diet and exercise report, and behavior modification class certificate (if required).
  • BCBS appeal process: If Blue Cross Blue Shield does not approve your pre-authorization for bariatric surgery, you will still have an option to file an appeal. With guidance from your surgeon, be prepared to counter each argument they have made to deny your coverage request. Follow the precise rules of the BCBS appeal process, and make your appeal within the stipulated time.
  • Affordable surgery options: In a situation where you fail to get approved for bariatric surgery from BCBS and your appeal is also rejected, it still does not mean that you should deny yourself good health and a long life. Explore low cost bariatric surgery options, such as medical tourism with a trusted service provider. This will enable you to eliminate obesity and reclaim your health within your budget.

Blue cross blue shield federal bariatric surgery requirements 2022

Does Blue Cross Blue Shield cover bariatric surgery for federal employees? The answer is yes, subject to your eligibility for the BCBS federal employees program. At the same time, the state laws related to weight loss surgery insurance coverage will also apply according to the state where you reside and work. Here are some of the key requirements for this coverage.

  • Age and BMI: You must have attained the age of 18 before you can be eligible for Blue Cross Blue Shield federal bariatric surgery coverage. Your BMI should be above 35 along with pre-defined co-morbidities or above 40 with or without obesity-related medical conditions.
  • Obesity diagnosis: To be eligible for coverage under Blue Cross Blue Shield federal weight loss surgery program, you may have to present medical records showing morbid obesity diagnosis for up to three years. Correlating with this, you may submit your PCP’s attestation to this effect.
  • Psychological evaluation: An independent, licensed psychiatrist or behavioral specialist may have to carry out a professional psychological before your scheduled bariatric surgery to determine your mental and emotional fitness to undergo the procedure.
  • Possible exclusions: Your Blue Cross Blue Shield federal bariatric surgery coverage may list policy exclusions. These may include experimental procedures, ongoing problem of substance abuse, terminal illness, psychopathology, pregnancy, or history of non-compliance with medical care.

Blue cross blue shield bariatric surgery policy

Does Blue Cross Blue Shield cover weight loss surgery? In general, the answer is yes, it does. However, the insurers in every state may have different rules for different groups. Moreover, each patient’s Blue Cross Blue Shield bariatric surgery policy may have slightly different terms and conditions, exclusions, and coverage limits.

  • When buying a Blue Cross Blue Shield weight loss surgery policy, find out which procedures are covered and what are the exclusions.
  • If you have insurance from your employer or through your spouse’s employer, check if they have opted out of BCBS bariatric coverage.
  • In a situation where Blue Cross Blue Shield bariatric surgery policy coverage is denied, check for clerical errors and ask for a reason.
  • In case of pre-authorization denial of Blue Cross Blue Shield weight loss surgery policy, consider filing an appeal with the insurer.
  • If your Blue Cross Blue Shield policy does not cover bariatric surgery, consider the lowest self-pay options and medical care financing.

Need more info on BCBS bariatric surgery coverage? Contact Us!

Does Blue Cross Blue Shield cover weight loss surgery? The answer is yes, as long as there is no specific exclusion clause to opt out of this coverage for lower premiums. However, even with valid BCBS bariatric surgery coverage, you will still have to meet certain eligibility requirements.

To learn how you might qualify for this coverage, call your insurance representative or talk to Jet Medical Tourism® to find out what alternatives you may have for an affordable out-of-pocket weight loss surgery. Call now for a free consultation!

Disclaimer: The Blue Cross Blue Shield and Anthem Blue Cross Blue Shield represent multiple health insurance companies in the United States. The insurance programs under these systems may or may not be applicable outside the US, depending on the terms of the policy. Different insurance companies may have different terms and conditions, which may change any time according to the state and federal laws and the discretion of the insurance company.

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