Does premera blue cross cover weight loss surgery

I know that BCBS approves the DS in some states. And frankly, I don't understand how a company can approve it under some plans and not under others (unless it's an exclusion). I mean, if they are saying that malabsorptive procedures are too dangerous, does that mean they are LESS dangerous if you live in New Jersey? Because they approve it in New Jersey. If they are saying it's "investigational", are they saying it is somehow LESS "investigational" in New Jersey? See what I mean? It makes no sense.  If there actually IS an exclusion, then they might have an argument--that is, that you haven't purchased coverage for it (or more appropriately, Microsoft hasn't purchased it for their employees). But even THEN, I'd still fight it if I were you. The reason I would fight it is because if there IS an exclusion, it should be an exclusion for any weight loss surgery. I don't see how Microsoft could possibly have purchased coverage for the RNY but not for the DS. Weight loss surgery is one covered benefit. If they are going to not allow certain procedures within the benefit, then they have to have a reason. But again, if their reason is that they consider malabsorption to be too dangerous or investigational, then that brings me right back to the argument in my first paragraph above. The actual surgical procedure should be between you and your doctor. I don't see how they can offer a benefit to their employees, and then try to dicatate which aspects of the benefit they will allow to apply. But hey, that's just me. Either way, fight it.

Dreamy
HW:303, SW:286, CW:148, GW:150     

Your Anthem Blue Cross insurance policy covers weight loss surgery unless it states specifically that it excludes it. In order to be pre-approved for the procedure you must meet the following requirements:

• You need must be between the ages of 18 and 60 years old
• Exceptions to the age requirement can be made for patients under 18 years old if a letter is provided to the carrier by the physician stating that there is a dramatic risk for the patient’s health if surgery is withheld. Additionally, the letter should contain information regarding the physician’s evaluation of the patient’s mental health and have determined that the patient is prepared for such a surgery
• You need to be at a documented BMI level of over 40, or
• You need to be at a documented BMI level of over 35 and suffer from a minimum of one comorbid condition such as:
  • Hypertension,
  • Obstructive sleep apnea,
  • Impaired glucose tolerance,
  • Type 2 diabetes,
  • Coronary artery disease.
• Written evidence must show that other weight loss programs have failed to help the patient reduce or control their weight. These other programs must have been utilized for a minimum of twelve months consecutively to be considered. Some of these programs should have been prescribed by a physician other than the weight loss surgeon and may include:
  • Weight Watchers
  • Jenny Craig
  • Top weight loss diet plans
  • Any medically supervised weight loss programs.

What Weight Loss Procedures Does Blue Cross Cover?

The weight loss procedures that Blue Cross covers include.

• Lap Adjustable Gastric Bands
• Vertical Banded Gastroplasty
• Duodenal Switch
• Biliopancreatic Bypass
• Gastric Sleeve Procedure
• Gastric Bypass

Procedures Blue Cross Does Not Cover

While Blue Cross does cover most of the weight loss procedures there are a few that they do not. These include:

• Open and Laparoscopic Sleeve Gastrectomy
• Open Adjustable Gastric Banding
• Laparoscopic and open vertical banded Gastrectomy

Other Considerations

While you go into the weight loss surgery with high hopes and expectations that it will be a success, there is always a possibility that it will not be as successful as you had hoped. If this is the case and you find a second surgery or procedure is needed, you might find that Blue Cross Blue Shield does provide coverage for a second surgery as long as you followed post-operative instructions and made lifestyle changes for success as well as turned to the bariatric surgeon and other sources for additional help. Blue Cross Blue Shield does cover a revision surgery if it is needed. They do require that certain documentation is provided by the physician including:

• Reasons for failure of the surgery
• Date and type of procedure
• Evidence of patient’s compliance with all post-operative instructions including diet and exercise regimens

Blue Cross Blue Shield does not require that you seek surgery with an in-network surgeon. They do recommend that you utilize their in-network surgeons, however, in order to take advantage of their Center of Excellence. You can obtain a list of these professionals from your Blue Cross Blue Shield agent if you would like to consider these individuals for your surgery. Make sure that the individual that you do choose to work with is able to submit directly to Blue Cross Blue Shield for coverage of your procedure.

Does Washington state health insurance cover weight loss surgery?

What weight do you have to be at to get weight loss surgery?

How much is gastric sleeve surgery in Washington state?

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