For individuals struggling with obesity and related health issues, bariatric surgery can be a transformative and potentially life-saving intervention. Many turn to their insurance providers, such as Blue Cross Blue Shield (BCBS), for assistance in covering the costs associated with these procedures. This article aims to provide a comprehensive overview of BCBS coverage for weight loss surgery, eligibility requirements, available options, and alternative solutions for those who may not have coverage.
Understanding Bariatric Surgery
Bariatric surgeries, also known as weight-loss or metabolic surgeries, are medical procedures designed to help individuals with obesity lose weight by making changes to their digestive system. These surgeries are typically considered when diet and exercise have proven ineffective, or when a person's weight poses significant health risks. Blue Distinction Centers and Blue Distinction Centers+ specializing in bariatric surgery offer quality care, treatment expertise and better patient results.
Types of Bariatric Procedures
Several types of bariatric surgeries are commonly performed, each with its own approach to weight loss:
- Gastric Sleeve: During gastric sleeve surgery, approximately 80% of the patient’s stomach is removed, creating a smaller, sleeve-shaped organ that restricts food intake.
- Gastric Bypass: Gastric bypass surgery involves creating a small pouch from the stomach and connecting it directly to the small intestine, bypassing a portion of the stomach and small intestine. This limits food intake and reduces calorie absorption.
- Vagus Nerve-Blocking Devices: Some options, such as vagus (or vagal) nerve-blocking devices, typically are not covered by Blue Cross Blue Shield insurance programs.
Blue Cross Blue Shield Coverage Policies
BCBS, one of the largest healthcare insurers in the United States, offers various policies that cover bariatric surgery. However, it’s essential to understand that these policies can vary significantly between states and individual plans. While most Blue Cross Blue Shield insurance programs cover at least some types of weight loss surgery, some employers may opt for cheaper insurance plans that don’t include bariatric surgery.
Eligibility Requirements
Many BCBS plans have similar policies concerning weight loss surgery. While the specific criteria may vary, common requirements include:
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- Body Mass Index (BMI): 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. 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.
- Age: Age isn’t the only requirement for eligibility under BCBS rules.
- Related Health Conditions: Individuals with a BMI of 35 or greater may be eligible for coverage if they have a serious related condition, such as type 2 diabetes, heart disease, or sleep apnea.
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. 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).
Navigating BCBS Coverage Variations
Given the variations in BCBS policies across different states and plans, it is crucial to verify your specific coverage details. For details on a provider’s in-network status or your own policy’s coverage, contact your Local Blue Plan and ask your provider before making an appointment.
Blue Distinction Centers
Blue Distinction Centers and Blue Distinction Centers+ specializing in bariatric surgery offer quality care, treatment expertise and better patient results.
Note: Designation as Blue Distinction Centers means these facilities' overall experience and aggregate data met objective criteria established in collaboration with expert clinicians' and leading professional organizations' recommendations. Individual outcomes may vary.
Blue Distinction Centers and Blue Distinction Centers+ for bariatric surgery provide a full range of bariatric surgery care; including surgical care, post-operative care, outpatient follow-up care and patient education. Access the provider directory of Blue Distinction Centers or Blue Distinction Centers+ designated providers for bariatric surgery.
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Alternative Options for Bariatric Surgery
Even if your BCBS plan doesn’t cover your bariatric surgery, there are still affordable options to help you achieve your goals.
Alternative Insurance
Finding a different insurer that does cover weight loss surgery is one possibility.
Payment Solutions
If that’s not practical, JourneyLite provides affordable payment solutions through partnerships with Kemba Financial Credit Union, CareCredit, and Prosper Healthcare Lending. Regardless of BCBS coverage for bariatric surgery, JourneyLite can help meet your weight loss goals. They offer various surgical and non-surgical options in tune with patients’ needs. Plus, they have flexible payment options through partnerships with several lenders. Patients can rely on them for high-quality, personalized care.
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