Anthem BCBS – Requirements for Weight Loss Surgery

anthem bcbs may cover weight loss surgery as long as your policy does not specifically exclude coverage. Obesity Coverage strongly believes that morbid obesity is a disease and that all insurance companies should cover these life-saving procedures. therefore, we are pleased to report that many anthem bcbs policies cover weight loss surgery. in fact, most of the blue cross blue shield network has some form of coverage for weight loss surgery.

It’s important to know that your employer can generally exclude weight-loss surgery insurance coverage for their employee policies. the exclusion usually saves the company money on your premiums. contact information for your bcbs anthem is below. Before you call, be sure to review our questions to ask before calling your insurance company.

Reading: How to know if my insurance covers gastric sleeve

note

blue cross of california is the brand name for anthem bcbs, so your criteria for weight loss surgery will be the same as here.

anthem bcbs pre-approval requirements

the elements below are the minimum necessary for the approval of your weight loss surgery.

• Body mass index (BMI) of 40 or more or…
• a bmi of 35 or more with at least 2 comorbidities.
• letter from primary care physician.
• active participation and documentation of non-surgical methods of weight loss.
• 18 years of age (special consideration if under 18 with severe morbid obesity and special circumstances).
• consultation and recommendation of a weight loss surgeon.
• psychological evaluation
• nutritional assessment

policies included in the coverage

• kentucky blue cross
• virginia blue cross
• wisconsin blue cross
• ohio blue cross
• california blue cross
• georgian blue cross
• missouri blue cross
• empire blue cross of new york

types of weight loss surgeries covered by anthem bcbs

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covered weight loss surgery procedures

• laparoscopic gastric bypass
• open gastric bypass surgery
• gastric banding, including gastric banding and performed banding
• duodenal interruption, also known as biliopancreatic diversion
• gastric sleeve surgery

Not sure which surgery is right for you? Take our bariatric surgery test!

Covered lap band fillers?

anthem bcbs believes that gastric banding meets a medical need when it is required to achieve the appropriate level of weight loss. this is true only if you have had a previous adjustable gastric band procedure that met all of the established criteria for that procedure. Generally, if you paid cash for the procedure, insurance will not cover ongoing gastric band fillers.

procedures excluded from coverage

• mini-gastric bypass
• vertical banded gastroplasty
• any other ‘experimental’ weight loss procedure

Is a second weight loss surgery covered if the gastric band didn’t work?

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Surgical procedures following prior weight loss surgery that did not result in adequate weight loss, such as a gastric band or performing band for a gastric bypass, gastric sleeve, or duodenal switch, are covered by insurance when the following criteria are met:

• the patient continues to meet all medical necessity criteria for bariatric surgery, and
• There must be documentation showing that the patient complied with the original postoperative diet and exercise program, and
• 2 years after original weight loss surgery, weight loss is still less than 50% of excess preoperative body weight and weight is still at least 30% of patient’s ideal body weight, by index of body mass.

reviews

• Revisions are covered if there is documentation of a failure secondary to a surgical complication. complications may include but are not limited to fistula, obstruction, or interruption of a suture/staple line.

does anthem bcbs require a center of excellence?

• yes, weight loss surgery should be performed in a center of excellence.

Do I have to use an in-network weight loss surgeon?

• not. however, your deductible and out-of-pocket costs may be significantly lower if you do. and you will still need to find a surgeon who has privileges to perform the surgery at an accredited center of excellence for bariatric surgery.

anthem bcbs contact information

Hymns can be reached at 1-866-293-2892. you can also find a contact number and email address on their website after choosing your state.

anthem bcbs full weight loss surgery coverage statement

Anthem’s full policy on weight loss surgery insurance coverage is no longer available online. the best option is to call them directly and ask if your policy includes coverage for cpt code 43775. this is the medical billing code for gastric bypass surgery. if your policy covers gastric bypass, it should also cover other bariatric surgery procedures.

Source: https://amajon.asia
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