Gastric sleeve, gastric bypass, and other weight loss surgical procedures can be life-saving for some patients. Unfortunately, in the U.S., insurance coverage for bariatric surgery is far from uniform, and most patients who do qualify don’t have coverage due to an exclusion.
Read on to find out if your Blue Cross Blue Shield insurance covers bariatric surgery.
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Does Blue Cross Blue Shield Insurance Cover Weight Loss Surgery?
Most Blue Cross Blue Shield insurance programs cover at least some types of weight loss surgery. Some options, such as vagus (or vagal) nerve-blocking devices, typically are not covered. Understand that some employers may opt for cheaper insurance plans that don’t include bariatric surgery. Be sure to check with your insurance provider for its specific requirements and restrictions.
BCBS Bariatric Surgery Requirements 2024
Many Blue Cross Blue Shield insurance programs have similar policies concerning weight loss surgery. For bariatric surgery to be considered medically necessary, all the following criteria must be met:
BMI
In most cases, a person with a BMI of 40 or more is considered eligible for weight loss surgery under BCBS regulations.
If a person has a BMI of 35 or greater and has one of the following conditions, BCBS will likely deem them eligible for bariatric surgery:
- Diabetes mellitus
- Hypertension
- Cardiovascular disease
- Life-threatening cardio-pulmonary conditions (such as severe obstructive sleep apnea or obesity-related cardiomyopathy)
A few BCBS policies will cover weight loss surgery if the person has a BMI of 30 or greater and type 2 diabetes
BMI CALCULATOR
Age
Most BCBS plans require the person to be at least 18, although some have provisions for adolescents.
Pre- and Post-Operative Requirements
BMI and age aren’t the only requirements for eligibility under BCBS rules. Many BCBS policies require documentation of things like:
- Previous participation in a weight loss program
- Pre-operative mental health and medical assessments and clearances
- Extensive preoperative education
- A treatment plan addressing the patient’s pre- and post-operative needs
Weight Loss Surgery Covered by Anthem Blue Cross
Anthem Blue Cross, which applies to more than 9 million lives across several states, does not cover weight loss surgery for people with a BMI of less than 35. However, for individuals who meet its requirements, it typically covers these types of weight loss surgery:
Lap Band
During Lap Band surgery, we surround the upper stomach with a silicone band to create a smaller stomach pouch, which promotes weight loss because the person feels fuller more quickly.
Gastric Sleeve
We remove about 80% of the patient’s stomach during gastric sleeve surgery to create a smaller, sleeve-shaped organ that holds less food. This aids in weight loss because the smaller stomach helps decrease hunger and food intake.
Gastric Bypass
Gastric bypass surgery, also called Roux-en-Y, decreases stomach size and modifies the digestive tract to restrict food intake and nutrient absorption.
BCBS Coverage Policies
While BCBS, one of the largest healthcare insurers in the United States, offers various policies that cover bariatric surgery, these can vary significantly between states and individual plans. Here’s how some plans differ:
BCBS Ohio Weight Loss Surgery Coverage
Because BCBS Ohio, which has over 3 million members, is part of Anthem Blue Cross, it doesn’t cover bariatric surgery for people with a BMI under 35.
Blue Cross Blue Shield Kentucky Bariatric Surgery Coverage
Like BCBS Ohio, Blue Cross Blue Shield Kentucky, which has nearly 2 million members, is operated by Anthem Blue Cross. People with a BMI under 35 aren’t covered for weight loss surgery under this plan.
BCBS Indiana Weight Loss Surgery Coverage
BCBS Indiana, which covers over 4 million people, is also included in Anthem Blue Cross, so it doesn’t offer coverage for weight loss surgery for people with a BMI of less than 35.
BCBS Michigan/Blue Care Network
BCBS Michigan/Blue Care Network, which covers nearly 5 million lives, has revised its policy on bariatric surgery to expand coverage for patients with a BMI of 30 to 35 with type 2 diabetes. To see the policy revisions from this carrier, click here: Revised weight loss surgery policy for BCBS Michigan/Blue Care Network.
Premera Blue Cross
Premera Blue Cross, which covers nearly 2.5 million lives, has also revised its policy and expanded coverage for patients with a BMI of 30 to 35 with type 2 diabetes (although they do have some glycemic control restrictions, requiring a hemoglobin A1c level above 7). To see the policy revisions from this carrier, click here: Revised weight loss surgery policy for Premera Blue Cross.
We’re hopeful that other BCBS plans will follow the example set by BCBS Michigan/Blue Care Network and Premera.
Alternate Payment Options
Even if your BCBS plan doesn’t cover your bariatric surgery, there are still affordable options to help you achieve your goals. Finding a different insurer that does cover weight loss surgery is one possibility. If that’s not practical, JourneyLite provides affordable payment solutions through partnerships with Kemba Financial Credit Union, CareCredit, and Prosper Healthcare Lending. We’re flexible and want to help you identify the best solution for your circumstances.
Frequently Asked Questions About Blue Cross Blue Shield Coverage for Bariatric Surgery
Our patients frequently ask questions about Blue Cross Blue Shield coverage for weight loss surgery. As a trusted provider, we have the information you’re looking for. Read on for additional information.
How Do I Maximize My BCBS Weight Loss Surgery Coverage?
To maximize your BCBS weight loss surgery coverage, be sure to follow all the regulations concerning preoperative weight loss attempts and medical and mental health assessments and clearances.
At What BMI Will Insurance Cover Weight Loss Surgery?
Many BCBS plans will cover weight loss surgery for people with a BMI of 40 or greater. People with a BMI of 35 or greater may be eligible for coverage if they have a serious related condition. A few plans will cover bariatric surgery for people with a BMI of 30 or greater if they have type 2 diabetes.
What Quality Certifications Does JourneyLite Have?
Programs like Anthem Blue Distinction Plus, Aetna Institute of Quality, and United Health Optum Bariatric Center of Excellence have recognized our quality of care. We’re also an MBSAQIP-Accredited Bariatric Surgery Outpatient Center of Excellence as designated by the American Society for Metabolic and Bariatric Surgery.
Find Effective, Affordable Weight Loss Surgery at JourneyLite
Regardless of BCBS coverage for bariatric surgery, JourneyLite can help meet your weight loss goals. We offer various surgical and non-surgical options in tune with our patients’ needs. Plus, we have flexible payment options through partnerships with several lenders. You can rely on us for high-quality, personalized care. Contact JourneyLite today to learn what we can do for you.
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