Does Blue Cross Blue Shield Insurance Cover Weight Loss Surgery and Bariatric Procedures

Blue Cross Blue Shield (BCBS) insurance may cover weight loss surgery and bariatric procedures, but the extent of coverage varies greatly depending on the specific plan and state.

BCBS has a network of providers that offer weight loss surgery, including gastric bypass, gastric sleeve, and gastric banding procedures.

Some BCBS plans may require a referral from a primary care physician before approving weight loss surgery.

BCBS may cover the costs of pre- and post-operative care, including hospital stays, anesthesia, and follow-up appointments.

Insurance coverage for weight loss surgery can be a complex and time-consuming process. Insurance companies that cover bariatric surgery often limit their coverage to certain types of surgery.

You'll need to call your insurance carrier to check if your plan provides coverage for weight loss surgery, and that you have covered benefits for morbid obesity surgery. Policies can change daily, so it's essential to verify your coverage.

Keep a record of the person you speak with, including their first name, last name, and direct phone number. This will come in handy if you need to follow up on your authorization.

Insurance companies use specific codes to identify the type of procedure or surgery. Here are some common codes you may need to provide:

Remember, your call to the insurance company should be for informational purposes only. The formal insurance authorization process will be initiated by your surgeon's office after you've met with the surgeon and scheduled your surgery date.

Blue Cross Blue Shield covers bariatric surgery, but you'll need to meet the specific eligibility criteria set by your insurance provider. This means showing that your procedure is a medical necessity.

You can receive Blue Cross Blue Shield bariatric surgery coverage, but it's essential to note that you'll only get actual coverage if you complete the necessary documentation for approval. This is true even if you're paying premiums for your policy.

To know if your Blue Cross Blue Shield policy covers bariatric surgery and if there are any exclusions, you should call your insurer or talk to your employer. Review the exclusions section in your health policy to see if weight loss surgery is a covered benefit.

Even if your policy covers bariatric surgery, you may still have out-of-pocket costs such as co-pays, deductibles, and maximums for out-of-pocket expenses. These limits are reset each calendar year, so it's a good idea to talk to your insurer ahead of time for more clarity.

The Blue Cross Blue Shield weight loss surgery program offers coverage for several bariatric procedures, including gastric sleeve and gastric bypass. These are considered the safest and most definitive solutions to morbid obesity.

In some cases, adjustable gastric band surgery (lap band) is also covered under Blue Cross Blue Shield bariatric surgery plans.

Insurance companies that cover bariatric surgery have varying requirements, and some may require medical records documenting medical problems caused by your weight or records of your participation in medically supervised weight loss programs.

You should call your insurance carrier to check if your plan provides coverage for weight loss surgery and that you have covered benefits for morbid obesity surgery. Keep in mind that policies can change daily.

To initiate the authorization process, our office needs a surgery date, and our surgical scheduler cannot start the process until then. You can also write down the name of the person you speak with at the insurance company, including their first name, last name, and direct phone number.

Here are the CPT/ICD-9 codes that insurance companies use to identify the type of procedure or surgery:

It may take up to 30 days for Blue Cross Blue Shield to approve your request for bariatric surgery.

Insurance appeals can be a frustrating and time-consuming process, but it's worth fighting for. You have a right to appeal a denial, and our program would not have submitted you for approval if we didn't think surgery was medically necessary.

If your insurance plan denies preauthorization for your surgery, you can file an appeal. According to Example 5, "Insurance Appeals", this can be done by you as a plan member, or you can appoint someone to assist you.

To make a strong appeal, you should carefully review and research what is needed. Our office will work with you to correct any errors and overturn the denial through an appeal.

Here are some key things to keep in mind when filing an appeal:

Note that each insurance plan is unique, and the appeal process may vary. It's essential to understand the specific requirements and procedures for your plan.

Entering Mexico can be a daunting experience, especially if you're not familiar with the country. You'll need to plan ahead to ensure a smooth transition.

If you're traveling to Mexico for gastric sleeve surgery, you'll want to research the best airports to fly into, with popular options including Cancun International Airport and Mexico City International Airport.

Make sure to check the entry requirements for Mexico, which include a valid passport and, in some cases, a visa. It's also a good idea to register with your country's embassy or consulate to stay informed about any travel advisories.

Mexico's proximity to the US makes it a popular destination for medical tourism, with many clinics and hospitals offering gastric sleeve surgery.

Anthem and BCBS cover various weight loss surgeries, including gastric sleeve, gastric bypass, and lap band. To determine if your insurance plan covers these procedures, you'll need to check your policy document or contact your insurer directly.

Anthem Blue Cross Blue Shield of California, for example, covers gastric sleeve surgery for individuals with a BMI of 35 or greater, after a written letter detailing prior weight loss attempts is submitted. The same applies to gastric bypass surgery, which is also covered under most Anthem BCBS health plans.

However, it's essential to note that pre-approval requirements vary depending on your insurance plan and location. This means you may need to undergo medically supervised non-surgical weight loss programs or obtain a surgeon's recommendation before getting approval for surgery.

Some Blue Cross Blue Shield plans may not cover bariatric surgery, but this will depend on the type of policy you have purchased.

If your BCBS plan excludes weight loss surgery, don't be discouraged - you can still explore low-cost self-pay options or consider offshore medical tourism.

An exclusion of bariatric surgery coverage shouldn't stop you from seeking a solution to your weight loss needs.

Here are some key points to keep in mind if your BCBS plan excludes bariatric surgery:

Anthem Blue Cross Blue Shield covers gastric bypass surgery, but it's essential to check your employer's plan to see if it's included.

You'll need to check the pre-approval requirements for your individual policy, which may include a consultation with a qualified weight loss surgeon.

Both traditional gastric bypass (open surgery) and laparoscopic Roux-en-Y gastric bypass procedures are usually covered in Anthem BCBS.

Anthem BCBS gastric bypass should be performed at a bariatric center of excellence, but not necessarily by an in-network surgeon.

To qualify for gastric bypass surgery, you typically need a BMI of 35 or greater, along with a written letter detailing all prior attempts at weight loss programs over the last 5 years.

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.

Here are the key issues to keep in mind for your Anthem BCBS gastric bypass coverage:

BCBS AZ may cover revision surgery for bariatric patients who require a change due to weight regain. This is determined on a case-by-case basis and based on medical necessity.

The most common revisions include a Lap-Band to Sleeve, Lap-Band to Bypass, or even a Sleeve to Bypass.