If you're considering weight loss surgery, you're in luck if you're a Federal BCBS Florida member. Federal BCBS Florida covers weight loss surgery for certain conditions, including obesity.
To be eligible, you'll need to meet the plan's requirements, which include having a body mass index (BMI) of 40 or higher, or a BMI of 35 or higher with one or more obesity-related health conditions.
This means that if you have a BMI of 40 or higher, or a BMI of 35 or higher with conditions like diabetes, high blood pressure, or sleep apnea, you may be eligible for coverage.
The plan also requires that you've tried other weight loss methods without success, such as diet and exercise, for a certain period of time.
Coverage and Benefits
If you're unsure about your federal BCBS Florida coverage, don't worry, it's easy to check. Contact the insurance provider directly to know if your plan covers Zepbound or other treatments.
You can start by calling the customer service department using the phone number on the back of your health insurance card or the official BCBS website. A customer service representative can guide you through your policy specifics and answer any questions you may have.
Some questions to ask include: Does my insurance plan cover Zepbound? How much will I have to pay if my insurance plan covers Zepbound? Does my doctor need to complete any particular actions, such as submitting a prior authorization (PA) form, before my coverage is approved?
Your insurance plan's deductible and what amount will your insurance plan cover are also important factors to consider. If your insurance plan does not cover Zepbound, you'll want to know how much you'll pay out of pocket.
Here are some common treatments that may be covered under federal BCBS Florida:
- Detox – Helps you safely go through the withdrawal process while you get rid of the harmful substances in your body.
- Inpatient or Residential Treatment– Patients will receive 24-hour care and support from professional addiction specialists.
- Outpatient Rehab – A more flexible approach to treatment, outpatient rehab allows patients to live at home and carry on with their day-to-day duties.
- Medications – While a patient receives substance abuse treatment, certain medications like suboxone or methadone may be used to help manage withdrawal symptoms and reduce cravings.
Co-occurring disorder treatment such as treatment of depression or anxiety as well as addiction treatment may also be covered under mental or behavioral health services. Depending on your level of coverage, mental health treatments may at least be partially covered.
Accepted Treatment Centers and Providers
If you have BCBS Federal or BCBS Florida, you'll want to know which treatment centers and providers are in-network. Fortunately, some facilities are specifically recognized by these health insurance providers.
River Oaks in Tampa, Florida, is one of the AAC facilities in-network with Florida Blue insurance. It offers a range of services including detox, residential treatment, and outpatient programs.
Recovery First in the Miami-Ft. Lauderdale area is another treatment center that's in-network with Florida Blue. They offer various levels of care as well as specialized programs for medical professionals, Veterans, and people quitting methadone.
If you're considering weight loss surgery, you'll need to go to a Center of Excellence. These are Blue Distinction Centers that can be found on the BCBS website.
Pre-Approval and Requirements
To get approved for weight loss surgery through BCBS Federal Employees Program, you'll need to meet some specific requirements.
First and foremost, you must have a Body Mass Index (BMI) of 40 or greater, or a BMI of 35 or more with certain health conditions, such as high blood pressure or diabetes.
You'll also need to show that you've tried other weight loss methods, like diet and exercise, without success.
A letter from your primary care physician is also required, as it provides a doctor's perspective on your situation.
You must be at least 18 years old to be eligible for weight loss surgery through BCBS Federal Employees Program.
The following procedures are typically covered: gastric bypass, Lap-band, and gastric sleeve surgery.
Here are the specific requirements in a concise list:
- BMI of 40 or greater, or BMI of 35 or more with comorbidities
- Documentation of failed diets by conservative treatment
- Letter of support from primary care physician
- Age 18 or older
- Approved surgical procedures: gastric bypass, Lap-band, and gastric sleeve
Weight Loss Surgery
Weight loss surgery is a covered benefit under BCBS FEP and BCBS Florida policies. Recently, gastric sleeves have started to be covered as a primary weight loss surgery option.
The following weight loss surgery procedures are typically covered by both policies: Laparoscopic Gastric Bypass, Gastric Sleeve, Open Gastric Bypass Surgery, Gastric Banding, and Duodenal Switch.
These procedures must be performed at a Center of Excellence, which can be found on the BCBS website.
Weight Loss Surgery Options
If you're considering weight loss surgery, you're likely looking for a procedure that's covered by your insurance. Some insurance companies, like BCBS FEP and BCBS Florida, cover certain types of weight loss surgeries.
Gastric sleeves have recently become a covered procedure by some large insurance companies, and they're typically covered by both BCBS FEP and BCBS Florida.
If you're interested in weight loss surgery, here are some options to consider:
Does Surgery Require a Center of Excellence?
If you're considering weight loss surgery, you may have questions about the requirements for your procedure. BCBS Federal and BCBS Florida require weight loss surgery to be done at a Center of Excellence.
These centers are specifically designated as Blue Distinction Centers and can be found on the BCBS website.
Frequently Asked Questions
Is Florida Blue the same as BCBS Federal?
Florida Blue is the servicing agent for the BCBS Federal program, also known as the Blue Cross and Blue Shield Federal Employee Program. This means they work together to provide health insurance benefits to federal employees.
Is Florida Blue the same as BCBS of Florida?
Florida Blue and Blue Cross and Blue Shield of Florida, Inc. are the same company, with the brand name changed to Florida Blue. The company's legal name remains unchanged.
Can I use BCBS of Florida in another state?
Yes, you can use BCBS of Florida in another state, as you'll be covered under the BlueCard Program and receive in-network benefits. Learn more about how this program protects you from balance billing when receiving services from a participating provider.
What is BCBS federal insurance?
BCBS federal insurance is a health insurance program provided by the Blue Cross and Blue Shield Service Benefit Plan, serving the federal employee workforce for over 60 years. It offers comprehensive coverage to federal employees and their families.
Sources
- https://thenp2go.com/does-blue-cross-blue-shield-federal-cover-zepbound-heres-what-you-should-know/
- https://americanaddictioncenters.org/insurance-coverage/blue-cross-blue-shield-florida
- https://www.labfinder.com/insurance/blue-cross-and-blue-shield-of-florida/
- https://policyalerts.com/bcbs-federal-employee-program-fep-medical-policy-updates-july-2022/
- https://www.obesitycoverage.com/bcbs-federal-employee-program-and-florida-blue-weight-loss-surgery-requirements/
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