Weight loss surgery, such as gastric sleeve and gastric bypass 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. This is especially true for patients in the JourneyLite treatment area. Although in many states weight loss surgery is an “essential benefit,” in Ohio, Kentucky, and Indiana it is not. This means that many of our patients must resort to self-pay options or pursue less effective but more affordable means of weight loss.
Although there is plenty of evidence that weight loss surgery has major benefits in diabetes with a lower BMI, traditionally even with policies that do offer coverage a patient must have a minimum BMI of 35. Things are slowly changing for the better though, as we see from some recent announcements by two different Blue Cross carriers.
BCBS Michigan/Blue Care Network
BCBS Michigan/Blue Care Network, which covers nearly 5 million lives, has revised their policy on bariatric surgery to expanded coverage for patients who have a BMI of 30-35 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
In addition, Premera Blue Cross, which covers nearly 2.5 million lives, has also revised their policy and expanded coverage for patients with a BMI of 30-35 with type 2 diabetes (although they do have some restrictions on glycemic control, 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
Hopefully these changes from two major carriers will result in a snowball effect, leading to broader coverage for these life-saving procedures.
To learn more about weight loss surgery and to see if one of these procedures might be right for you, click here to try our online weight loss navigator!