Blue Cross Requirements for Weight Loss Surgery
The average weight of Americans has doubled in the past 30 years, according to the CDC. Weight loss surgery is considered an effective treatment of morbid obesity. While most of the Blue Cross insurance policies do cover weight loss surgery, not all of them do. Those that do cover the procedure have similar requirements to those of Blue Cross Blue Shield (BCBS) of Michigan. It is important that you meet these criteria in order to benefit from the insurance company’s coverage for the entire process.
Requirements for Pre-Approval of Weight Loss Surgery with Blue Cross
Your Anthem Blue Cross insurance policy covers weight loss surgery unless it states specifically that it excludes it. In order to be pre-approved for the procedure you must meet the following requirements:
- You need must be between the ages of 18 and 60 years old
- Exceptions to the age requirement can be made for patients under 18 years old if a letter is provided to the carrier by the physician stating that there is a dramatic risk for the patient’s health if surgery is withheld. Additionally, the letter should contain information regarding the physician’s evaluation of the patient’s mental health and have determined that the patient is prepared for such a surgery
- You need to be at a documented BMI level of over 40, or
- You need to be at a documented BMI level of over 35 and suffer from a minimum of one comorbid condition such as:
- Hypertension,
- Obstructive sleep apnea,
- Impaired glucose tolerance,
- Type 2 diabetes,
- Coronary artery disease.
- Written evidence must show that other weight loss programs have failed to help the patient reduce or control their weight. These other programs must have been utilized for a minimum of twelve months consecutively to be considered. Some of these programs should have been prescribed by a physician other than the weight loss surgeon and may include:
- Weight Watchers
- Jenny Craig
- Top weight loss diet plans
- Any medically supervised weight loss programs.
What Weight Loss Procedures Does Blue Cross Cover?
The weight loss procedures that Blue Cross covers include.
- Lap Adjustable Gastric Bands
- Vertical Banded Gastroplasty
- Duodenal Switch
- Biliopancreatic Bypass
- Gastric Sleeve Procedure
- Gastric Bypass
Procedures Blue Cross Does Not Cover
While Blue Cross does cover most of the weight loss procedures there are a few that they do not. These include:
- Open and Laparoscopic Sleeve Gastrectomy
- Open Adjustable Gastric Banding
- Laparoscopic and open vertical banded Gastrectomy
Other Considerations
While you go into the weight loss surgery with high hopes and expectations that it will be a success, there is always a possibility that it will not be as successful as you had hoped. If this is the case and you find a second surgery or procedure is needed, you might find that Blue Cross Blue Shield does provide coverage for a second surgery as long as you followed post-operative instructions and made lifestyle changes for success as well as turned to the bariatric surgeon and other sources for additional help. Blue Cross Blue Shield does cover a revision surgery if it is needed. They do require that certain documentation is provided by the physician including:
- Reasons for failure of the surgery
- Date and type of procedure
- Evidence of patient’s compliance with all post-operative instructions including diet and exercise regimens
Blue Cross Blue Shield does not require that you seek surgery with an in-network surgeon. They do recommend that you utilize their in-network surgeons, however, in order to take advantage of their Center of Excellence. You can obtain a list of these professionals from your Blue Cross Blue Shield agent if you would like to consider these individuals for your surgery. Make sure that the individual that you do choose to work with is able to submit directly to Blue Cross Blue Shield for coverage of your procedure.
Related Resources
Am interested in gastric surgery
Dose Arkansas Blue Cross Blue Shield Silver Plan AW1 cover Gastric sleeve surgery
I am trying to find a document that includes everything I need to know about being approved and coverage costs related to having bariatric surgery coverage.
Did you find it? I called & the reps have very little information on Bariactric Surgery.
Can I get specific requirements for revisional surgery from a 2013 sleeve gastrectomy to a Roux-en-y surgery?
Did you ever hear back?? I am interested in the same.
Does BCBS SC Peba cover this
Would like to know if Blue Cross Blue Shield pay for weight loss surgery.
5’7
267
Have some health problems
Don’t drink don’t smoke and do not do drugs
I didn’t try so many diets is nothing is working
does BCBS of alabama cover this?
I would like to have more information about getting coverage… i was on a group plan but job no longer carrier this company after 13 years……iam looking so still get the coverage back
My I been waiting on this, I can’t walk 10 steps and.i am out of breath my legs feel so heavy. Ok. At 232 so this is gonna help me so much
Does BCBS of Louisiana Pelican HRA cover this? I meet the listed requirements.
Why is there an age cut off at 60? WIll a letter stating the medical necessity of surgery for someone older than 60 suffice? This seems like a discriminatory practice …
Is the upper age limit of 60 correct? When I talk to reps they say this is not accurate.
I am in the process of getting the sleeve and I just started. I turn 61 the end of October so am worried sick I can’t get everything done GeForce then! I hope you are correct about being over 60! I’m going to call tomorrow
Been going to bariatric center. It is not working. Does bcbs of SC pay for gastric surgery?
Do Blue Cross Blue Shield for Arkansas cover the gastric sleeve procedure
Looking into revision. I lost somecwright but never got to goal. Still at 170s and 5ft. Started at 210.
Hello, I meet the requirements for bariatric surgery, however I can’t get anyone to tell me the BCBS plan that covers the surgery.
Does BcBs of Tn cover Bariactric surgery
I thot cut off age 71
I had lapband for 7 yrs. It was removed by emergency. I was informed by my doctor no revision but would replace with gastric sleeve after recovery. Now I’m being told u have to gain back the weight I worked so hard to keep off.. and my medical issues resolved alot …before I can be approved for revision to gastric sleeve. This is devastating. I’m regaining weight my bp up etc. Is this true . I use the analogy I purchase a new tire i need new one. Is it true I am looked at like a new patient? Seriously?
Hello Deborah,
There is always a chance of regaining weight based on habits, diet, and lack of exercise, but revision surgery is always available. The first step would be to fill out a health questionnaire with our collaborative partner, Mexico Bariatric Center. It’s free and confidential. These doctors can examine your medical history to see if you are an ideal candidate.
https://mexicobariatriccenter.com/health-questionnaire/
I am trying to see if I was approved to have The gastric sleeve done
Your first step would be to fill out a health questionnaire with our collaborative partner, Mexico Bariatric Center. It’s free and confidential.
https://mexicobariatriccenter.com/health-questionnaire/
Yes you are approved.
Will BCBS of Tennessee covering Weightloss surgery in 2022 I live in La.
i am 71 will bcbs cover weight loss surgery at me age?
Would love more information I suffer from thyroid disease and none of the medication is working for me we have tried everything including diet and exercise.
You can fill out this form to see what options are available for you: https://obesityreporter.com/apply-bariatric-surgery-health-questionnaire/
I have NASH/NAFLD
I have HOCM
Hypertension
Hyperlipidemia
Knees and hip replacement
Acid reflux
Sleep apnea
I’m 73 but active.
Why is 73 too old?