2 years after the original weight loss surgery, weight loss is still less than 50% of pre-operative excess body weight and weight remains at least 30% of the patients ideal body weight, per BMI.There must be documentation that the patient was compliant with the original post-operative dietary and exercise program, and.The patient continues to meet all the medical necessity criteria for bariatric surgery, and.Surgical procedures following a previous weight loss surgery that did not result adequate weight loss, such as a lap band or realize band to a gastric bypass, gastric sleeve or duodenal switch are covered by insurance when the following criteria are met: Is a Second Weight Loss Surgery Covered if Gastric Banding Didn’t Work? Any other ‘experimental’ weight loss procedure.Typically, if you paid cash for the procedure ongoing lap band fills will not be covered by insurance. This is true only if you’ve had a previous adjustable gastric banding procedure that met all of the criteria laid out for that procedure. Unsure which surgery is right for you? Take our bariatric surgery test!Īnthem BCBS considers Lap Band fills a medical necessity when required to meet the proper level of weight loss. Duodenal Switch also known as Biliopancreatic Diversion.Gastric Banding – including the Lap Band and Realize Band.Types of Weight Loss Surgeries Covered By Anthem BCBS Consult and recommendation from a weight loss surgeon.18 years of age (special consideration if under 18 with severe morbid obesity and special circumstances).Active Participation and Documentation of non-surgical methods of weight loss.a BMI of 35 or greater with at least 2 comorbidities.Body Mass Index (BMI) of 40 or greater OR….The items below are the minimum necessary for approval of your weight loss surgery. Before calling make sure you see our questions to ask before calling your insurance company.īlue Cross of California is the trade name for Anthem BCBS so your criteria for weight loss surgery will be the same as it is here. Contact information for your Anthem BCBS is listed below. Opting-out typically saves the company money on their premiums. It is important to know that your employer can typically opt-out of weight loss surgery insurance coverage for their employees’ policies. In fact, most of the Blue Cross Blue Shield network has some sort of coverage for weight loss surgery. So we are happy to report that many Anthem BCBS policies cover weight loss surgery. Obesit圜overage strongly feels that morbid obesity is a disease and every insurance company should cover these life saving procedures. The information provided on this site is for general informational purposes only, and does not replace the need for a formal consultation.Anthem BCBS may cover weight loss surgery as long as your policy does not specifically exclude coverage.

'*The content/images on this website are not a guarantee of individual results. This also includes required dietary evaluations and nutritional counseling before and after your surgery to ensure maximum health and recovery. It is also necessary for your physician requesting the coverage to fully explain the gastric sleeve surgery to you so that you completely understand the risks, benefits and how the procedure is performed. 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. 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. A diet and psychiatric evaluation are also required by Anthem Blue Cross Blue Shield in California. This may be required by Blue Cross or Blue Shield prior to covering any bariatric procedure. Part of determining if Blue Cross or Blue Shield cover your gastric sleeve surgery is determining you have a Body Mass Index (BMI) 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. 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. Anthem Blue Cross Blue Shield Gastric Sleeve CoverageĮvery person is different, and so is each insurance plan Anthem Blue Cross and Blue Shield of California’s Gastric Sleeve Coverage and pre-approval requirements vary with every insurance policy and potential patient.

Anthem blue cross weight loss coverage