Does blue cross blue shield insurance cover weight loss surgery

1. BCBS may cover weight loss surgery, but it depends on your specific plan. There are many different BCBS plans offered across the country, and each plan has its own coverage details.

2. Coverage is typically for medically necessary procedures. BCBS generally considers weight loss surgery to be medically necessary if you meet certain criteria, such as having a body mass index (BMI) of 40 or more, or a BMI of 35 or more with a weight-related health condition like type 2 diabetes.

3. You will likely need to meet pre-approval requirements. This may involve attending consultations with healthcare professionals, documenting your weight loss attempts, and getting a letter of medical necessity from your doctor.

4. Specific covered procedures may vary. Some plans may cover certain procedures, like gastric sleeve surgery or Roux-en-Y gastric bypass, while excluding others, like lap band surgery or biliopancreatic diversion with duodenal switch (BPD-DS).

5. Out-of-pocket costs can still be significant. Even with insurance, you may still be responsible for deductibles, co-pays, and coinsurance.

6. Check your plan documents or contact your BCBS provider for specific details. This is the best way to find out for sure if your plan covers weight loss surgery and what the specific requirements are.

7. BCBS offers a Blue Distinction® Centers for Bariatric Surgery program. This program identifies hospitals and surgical centers that meet certain quality standards for bariatric surgery. Using a center in this program may improve your chances of getting coverage.

8. Consider the long-term costs and commitment. Weight loss surgery is a major decision with significant long-term implications. Be sure to weigh the costs and benefits carefully before making a decision.

9. There may be alternative weight loss options covered by your BCBS plan. These could include lifestyle counseling, weight loss medications, or medically supervised weight loss programs.

10. If weight loss surgery is not covered by your BCBS plan, you may have other options. These could include exploring other plans, financing the surgery yourself, or looking into weight loss programs that are not covered by insurance.