Tuesday, April 16, 2024

What Bcbs Plan Covers Bariatric Surgery

Anthem Blue Cross Blue Shield Contact Information And Full Medical Policy On Bariatric Surgery

Bariatric Surgery: What You Need to Know
  • Individual & Family Plans

Before getting into the types of insurance plans, you can cut to the chase by contacting a local bariatric surgeons office. Most surgeons will contact your insurance company for free to confirm whether or not youre covered.

Anthem Blue Cross Blue Shield does cover weight loss surgery, but your specific policy must include it in order for you get it covered.

Following are a list of Anthem Blue Cross Blue Shield plan types and whether they cover bariatric surgery:

What Is A Letter Of Pre

A letter of pre-determination or pre-certification from your insurance company means their medical review department has decided, based on the information provided, that your surgery is medically necessary. But this does not mean they will cover your surgery. That depends on your individual insurance policy.

We will submit the necessary documentation to your insurance company. Please do not ask any other physician to submit anything directly to your insurance company. They can provide necessary documentation to us, and we will submit everything as the insurance company requires.

How To Get Insurance To Pay For Bariatric Surgery By Demonstrating Medical Necessity

Most insurance plans require that medical necessity be demonstrated before coverage is granted for weight-loss surgery. This means that in addition to your consultation with them, youll need to provide evidence that bariatric surgery is necessary for each patient. The exact criteria vary from one insurance provider to the next but typically include the following.

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How Much Does Weight

The average bariatric surgery costs $17,000 to $26,000, according to the ASMBS. Mounting evidence shows that surgery for morbid obesity can be more cost-effective than treating the conditions resulting from obesity. However, even with your doctors recommendation, your health insurance might not pay for the surgery.

The exact cost differs by surgery, circumstances and potential complications. However, ASMBS estimated that the surgery usually leads to lower health care costs and improved worker productivity, which are reasons why health plans usually approve the surgery if you qualify.

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.

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Does Bariatric Surgery Insurance Have A Waiting Period

Yes, bariatric surgery in health insurance has a waiting period of usually 2 to 4 years. Which means, if you want to cover your expenses for bariatric surgery you will have to wait for 2 years from the start of your policy. So, it is always advisable to opt for such a benefit with your first health insurance policy itself.

First Step: Before Calling The Insurance Company

1. Research and select a couple of bariatric surgeons you are interested in.

2. For each surgeon, check our site to see if information is available about what dietician and psychologist that surgeon usually sends his or her patients to.

3. Start a folder to contain paperwork for all your insurance dealings and be ready to take notes from your call for safe keeping here.

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Are Revisional Surgeries Covered

Revisions are covered when the original procedure does not achieve long term weight loss goals. But the patient must show proof that they have been compliant with the post-operative diet and exercise routines. The surgeon must show that the original gastric pouch dilated or the band slipped or eroded.

Qualifying For Bariatric Surgery:

Bariatric Surgery Benefit

A person must have a body mass index of 40 or greater, or BMI of 35 or greater with an obesity-related co-morbid condition including, but not limited to:

  • Diabetes mellitus, Type II
  • Life threatening cardio-pulmonary problems,
  • Documentation of all of the following:

  • Participation in a weight loss program. The individual must have actively participated in the program for at least 3-6 months and
  • Pre-operative medical and mental health evaluations and clearances and
  • Pre-operative nutritional counseling with a Registered Dietitian and
  • Pre-operative education which addresses the risks, benefits, realistic expectations and the need for long-term follow-up and adherence to behavioral modifications
  • **Please Note: All clinical guidelines and qualifying factors vary based on insurance company and the policies in place. If you have specific questions regarding your health insurance policy, please contact our office at , option 2.

    The University of California, Los Angeles is designated as:

  • United Health Care Optum Center of Excellence Network
  • Blue Cross Blue Shield Bariatric Resource Service
  • Aetna Institute of Quality
  • MBSAQIP Accredited Center
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    Criteria For Coverage Of Surgery Costs

    In order for Medicaid to cover the cost of your surgery and the associated surgeon visits, you must meet the requirements below.

    • Over the age of 13 for a female and 15 for a male.
    • Body Mass Index must be over 35 with at least one comorbidity.
    • Co-morbidities include sleep apnea, high blood pressure, high cholesterol, diabetes.
  • If you are under 21, you must have a Body Mass Index over 40 with at least one comorbidity.
  • A letter from your primary care physician stating that weight loss surgery is medically necessary.
  • Passes a psychological exam.
  • Documentation showing that the patient tried to manage their comorbidities with standard treatment but they were not successful.
  • The patient must complete and show documentation that he or she participated in a medically supervised weight loss program for 6 months and it happened within the last 12 months prior to surgery.
  • The patient must understand they will be required to change their diet and lifestyle after surgery.
  • Nutritional and psychological services must be available before and after surgery .
  • You Might Not Qualify for Weight Loss Surgery Coverage if:

    • Long-term steroid use
    • Inflammatory bowel disease, chronic pancreatitis, pregnancy, or non-compliance with medical treatment.
    • Psychological treatment that might interfere with post-operative compliance with diet and lifestyle.

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    Weight Loss Surgery Insurance Secrets

    When you have made the big decision to achieve permanent freedom from obesity, nothing should come in your way to qualify for weight loss surgery insurance. However, in reality, many patients experience challenges in getting approvals or face claim denials from their insurers. Here are five proven weight loss surgery insurance secrets that will help you obtain approval for maximum coverage from your insurance company.

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    Anthem Weight Loss Surgery How To Avoid A Denial

    Your Anthem Blue Cross Blue Shield weight loss surgery insurance coverage depends on several factors, all of which are reviewed below.

    First, try our insurance tool to quickly check your insurance coverage:

    Read and click below for additional weight loss surgery insurance details.

    • 35+ Body Mass Index
    • Documentation of failed diet attempts
    • Psychological evaluation

    Can Anyone Get Weight Loss Surgery

    Which Insurance Is Best For Bariatric Surgery

    No, itâs not always possible for anyone to get weight loss surgery. This is because itâs not always the best course of action for everyone. It also depends on whether you receive treatment through the public system or privately.


    To be eligible for treatment in the public system , you need to have a body mass index of at least 35, demonstrate that youâve failed using other approaches and youâll have to undergo a psychological evaluation. Youâll also have to find a public hospital that will do this sort of treatment, of which there are only a few in Australia.

    Private health

    Private health insurers will require you to have a face-to-face consultation with a physician to determine if the surgery is necessary and some insurers require you to have a BMI above a specific number. However, these requirements are less restrictive than Medicare and you will have more choice of hospitals.

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    Body Mass Index Above 40

    Most insurance companies will require that patients have a body mass index of 40 or above to be candidates for bariatric surgery.

    Alternatively, patients with moderate obesity may be candidates for bariatric surgery if they have a BMI of at least 35 and there are co-morbidities present such as high blood pressure, type 2 diabetes, clinically significant obstructive sleep apnea, coronary heart disease, or hypertension.

    Some insurance companies may require your patient to be moderately or morbidly obese for a particular duration of time before surgery is approved.

    How Long Does It Take Medicaid To Approve Weight

    Medicaid also allows weight-loss surgeries if you meet criteria, but recent studies show approval make take longer.

    Insurers usually take a month to approve weight-loss surgeries. However, wait times for Medicaid approval can take five months or more. During that time, Medicaid will review your records and input from your doctor before making the decision.

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    So How Does Bariatric Surgery Insurance Work

    Few years back, bariatric surgery was a standard exclusion across the industry. However, with the changing needs of the world and the technical advancements, bariatric surgery is considered by many insurance companies now. If you are hospitalized for a Bariatric Surgery which is medically necessary, on the advice of a Medical Practitioner, we cover the related medical expenses. However, it is to be kept in mind that Bariatric Surgery Insurance benefit can be availed only when it is medically necessary and not for cosmetic purposes.

    States Where Insurance Is Required To Cover Bariatric Surgery

    Weight Loss with Bariatric Surgery | Sleeve Gastrectomy & Gastric Bypass | theSITREP

    Under the Affordable Care Acts Essential Health Benefits Benchmark Plans, 23 states require that all individual, family, and small group insurance plans cover bariatric surgery. Those states are:

    Also under the ACA, in the following three states, bariatric surgery coverage must be offered in at least some policies:

    • Georgia, where a 1999 state law also mandates coverage for morbid obesity
    • Indiana, where a 2000 state law also mandates coverage for morbid obesity
    • Virginia, where a 2000 state law also mandates that coverage for morbid obesity must be offered in at least one plan by each state-regulated health insurer

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    Does Anthem Blue Cross Georgia Cover Bariatric Surgery

    One of the first questions that our Georgia patients ask is whether their insurance will cover bariatric surgery and if so, what will their out-of-pocket expense be?

    Anthem Blue Cross Georgia is the largest health insurer in the state with over 1,000,000 policies and over 30% market share. As a result, Blue Cross is often at the forefront of insurance company policy changes as they relate to coverage of bariatric surgery and other procedures.

    The most important thing to understand about any health insurance policy is that beyond the list of covered procedures, there are also specific exclusions. Bariatric surgery is a common exclusion and a read through your policy documents and calling Anthem Blue Cross Georgia can give you clarity on your specific policy. We can also assist you in verifying your benefits, but it is important that you speak to your insurance to clarify any questions you may have.

    Does Blue Cross Blue Shield Florida Blue Cover Bariatric Surgery

    Blue Cross Blue Shield of Florida, now known as Florida Blue, is our states largest health insurance provider, with over 50% of Floridians covered under their plans. BCBS offers members a range of plans, including Individual & Family, Medicare, and Group Health. MASJax providers are in-network for most of these plans. Our team is happy to discuss your benefits and coverage for weight loss surgery and help guide you through what is required for coverage.

    Note: In-network providers can offer lower costs than those out-of-network.

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    Should I Pay In Cash Or Use Insurance

    When considering getting a bariatric procedure done, insurance is the ideal way to go. However, whether you should pay out of pocket or through insurance will depend on the type of policy you have. Today, most major insurance carriers cover laparoscopic gastric bypass, gastric sleeves, and lap band surgeries. However, that does not mean your health plan also provides coverage for such procedures.

    While some plans entirely exclude bariatric surgery, others may require you to pay more to include coverage for weight loss procedures, Read your individual health policy carefully or ask your agent to know whats covered and whats not.

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    Must You Go To A Center Of Excellence And In

    Anthem BCBS

    The surgery must take place at a Center of Excellence. However, you do not have to use an in-network surgeon. But, the costs will be higher for you if you use an out of network doctor. They will also need to have privileges to perform the weight loss surgery at the accredited Center of Excellence.

    You can contact Anthems customer service at 1-866-293-2892. You can also look on their website www.anthem.com for the email address and contact number.

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    Blue Cross Blue Shield Of New York Contact Information And Full Medical Policy On Bariatric Surgery

    • Individual & Family Plans

    Before getting into the types of insurance plans, you can cut to the chase by contacting a local bariatric surgeons office. Most surgeons will contact your insurance company for free to confirm whether or not youre covered.

    Blue Cross Blue Shield of New York does cover weight loss surgery, but your specific policy must include it in order for you get it covered.

    Following are a list of Blue Cross Blue Shield of New York plan types and whether they cover bariatric surgery:

    Use Modern Tools To Help With Insurance Approvals And Billing

    Knowing and consistently applying the latest criteria from each insurance company is critical to ensuring your patients are able to be approved for surgery.. You can further simplify the insurance process for you and your patients by using the latest tools to help tailor the evaluation requirements and streamline the pre-authorization process.

    Find out how Wellbes personalized care automation can help you streamline insurance approvals and billing, as well as hundreds of other non-medical administrative tasks.

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    How To Get Bariatric Surgery Covered By Insurance

    In certain situations, your health insurance may cover the cost of bariatric surgery. In addition, some states are required to cover bariatric surgery if you have an ACA-compliant health insurance plan through the Marketplace.

    However, weight loss surgery is not automatically covered by every policy, and for every person. If you want to get your health insurance provider to cover weight loss surgery, heres what you need to do:

  • Check the details of your health insurance policy: The first step is to review your policy details to see if bariatric surgery is a covered procedure. You also can contact your insurance company and speak with an agent, who can walk you through the fine print of your policy and whats covered.
  • Find a surgeon that is in your network: Next, youll want to choose a surgeon who is in your health plan network. Depending on your plan, a portion of the cost may be paid for if you visit an out-of-network provider. However, because bariatric surgery can be very expensive, seeing an in-network doctor will likely reduce your out-of-pocket cost significantly.
  • Does Health Insurance Cover Weight Loss Surgery

    What is Bariatric Surgery?

    In many cases, health insurance will cover weight loss surgery, but its not guaranteed. Insurance coverage for weight loss surgery varies with insurance policies. However, most insurance policies will cover bariatric surgery, assuming that the patient meets the qualification requirements, according to Dr. Garber. In addition, insurance eligibility for weight loss changes often, so Dr. Garber recommends working with your insurance provider and your bariatric surgeon to determine if surgery will be covered.

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    Your State Not On The List

    If your state is NOT on the list, then weight loss surgery is probably NOT covered under your plan.

    First, contact your local surgeon to be sure. For no charge, their office will contact your insurance company on your behalf to work through the details.

    If your surgeon confirms that your policy does not include obesity surgery, you still have several options for making surgery more affordable. See these pages for more information:

    Anthem Blue Cross Blue Shield Gastric Sleeve Coverage

    Every person is different, and so is each insurance plan Anthem Blue Cross and Blue Shield of Californias Gastric Sleeve Coverage and pre-approval requirements vary with every insurance policy and potential patient. Per the most recent Anthem Blue Cross Blue Shield Clinical Bulletin SURG.0024, Gastric Sleeve is now covered and available for those individuals who qualify.

    Part of determining if Blue Cross or Blue Shield cover your gastric sleeve surgery is determining you have a Body Mass Index of 35 or greater, along with obtaining a written letter detailing all prior attempts at weight loss programs, including diet and exercise, over the last 5 years. This may be required by Blue Cross or Blue Shield prior to covering any bariatric procedure. A diet and psychiatric evaluation are also required by Anthem Blue Cross Blue Shield in California. If your BMI is below 40, Anthem Blue Cross and Blue Shield will also consider all medical issues and problems related to your weight prior to authorizing coverage of your Gastric Sleeve Surgery. Depending on your Blue Shield or Blue Cross Gastric Sleeve Coverage, you may also be required to undergo 6 to 12 months of medically supervised, non-surgical attempts at weight reduction through nutrition, medication or maintenance therapy, behavior modification, exercise and increased activity.

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