Requirements For Insurance To Cover Weight Loss Surgery

Contact Our Helpful Advisors Here. Eligible patients must also have attempted and failed at previous weight loss efforts and need to pass a psychiatric evaluation to be recommended for weight loss surgery.

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Are between 18 and 75 years old.

Requirements for insurance to cover weight loss surgery. Most insurance companies provide coverage for medically necessary weight loss surgery but coverage depends on several criteria and varies by state and by insurance provider. Pregnancy or significant weight fluctuations can create a pocket of. Requirements for Pre-Approval of Weight Loss Surgery with Blue Cross.

Here are the most common requirements. Requirements for Pre-Approval of Weight Loss Surgery with Cigna. If your surgeon recommends weight-loss surgery he or she will submit medical documentation to obtain pre-authorization from your insurance company.

5 feet 3 inches. The goal of this documentation is to establish the medical necessity of weight-loss surgery. The patient must have tried futilely in at least one weight loss program that is medically approved and supervised.

37 rows Bariatric Surgery. Similar to other insurers Medicare will likely require a BMI of at least 35 your weight must also be causing serious health issues and youve attempted for years to lose weight through diet and exercise. And have attained a majority of.

Your Anthem Blue Cross insurance policy covers weight loss surgery unless it states specifically that it excludes it. Cardiovascular disease including high blood pressure high cholesterol or significant heart disease. Some of the common requirements are.

Patients who qualify for gastric sleeve surgery usually. Have a body mass index BMI of 40 or higher or have a BMI between 35 and 40 and an obesity-related condition such as heart disease diabetes high blood pressure or severe sleep apnea. You and your doctor need to get pre-approval for weight-loss surgery.

However protocols are a bit more stringent if you want insurance to pay such as requiring a 35 BMI and a completed medically supervised weight loss program. BCBS Illinois Pre-Approval Requirements. Medicare will pay for abdominoplasty or a tummy tuck after weight loss surgery if it is deemed medically necessary due to excess skin that causes rashes or infections.

However to qualify for coverage of weight loss surgery your policy must include coverage. Minimum 18 years of age or above some plans cover surgery less than 18 years of age also. Some States Require Insurance to Cover Weight Loss Surgery SECTION SUMMARY.

Most insurance companies have similar criteria when approving a patient for bariatric surgery. In order to be pre-approved for the procedure you must meet the following requirements. Your BMI is 35 to 40 AND you have a major health complication such as.

Letter of Medical Necessity. Have a BMI body mass index of at least 40 or a BMI of 35 and above with one or more obesity related comorbid condition calculate your BMI. Unless you have a policy that specifically excludes weight loss surgery surgery is going to be covered provided that you meet specific criteria set forth by Cigna.

For most patients you will be REQUIRED to take 2 multivitamins 1 Vitamin B12 and 6 Calcium Citrate tablets per day. Must have had obesity for up to 5 years and have documents to prove it. These are not an option and for the majority of patients will be purchased as over-the-counter supplements at your local.

Your BMI is 40 or more OR. You can always appeal its decision to deny you coverage. These requirements include all of the following.

If your weight loss surgery insurance company refuses to cover your weight-loss surgery even after youve met all its requirements try not to panic. To be eligible for weight-loss surgery you must meet the following requirements. Consideration for bariatric surgery is generally warranted only when adolescents have experienced failure of 6 months of organized weight loss attempts and have met certain criteria.

Insurance companies generally consider you eligible for weight loss surgery coverage if. Most insurance companies require a Letter of Medical Necessity for bariatric surgery pre-authorization. Insurance companies follow requirements for weight loss surgery.

You must pass a psychological evaluation. Posted May 2 2013. You need to be at least 18 years old.

What is a Panniculus. Are at least 80 lbs 36 kg overweight. Various services and procedures also require referral andor prior authorization.

A recommendation letter from your doctor approving the surgery. Document other weight-loss attempts made through diet centers and fitness club memberships. Keep good records including receipts.

First get a copy of your policy. 23 states now have a specific health benefit. I just went to the doctors yesterday and i got a surgery date for 627 penning insurance fidelis fingers crossed it wont take long.

Weight Loss Surgery Eligibility. The Affordable Care Act Obamacare requires insurance coverage for weight loss surgery in almost half of all states. How long does it take Medicaid to approve weight-loss surgery.

The benefit plan of the patient should explicitly include weight loss surgery. Weight loss surgery helps obese and morbidly obese individuals improve their health. Contact Our Helpful Advisors Here.

As not all policies include coverage please talk directly to BCBS Illinois to find out if you policy includes coverage. Severe obesity a BMI of 40 and severe co-morbidities or super obesity BMI of 50 and less severe co-morbidities that may be remedied with weight loss. You need must be between the ages of 18 and 60 years old.

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