Insurance claim form filed

BCBS Of Nebraska – Criteria For Weight Loss Surgery

In Am I Covered by OC Staff

Blue Cross Blue Shield Nebraska covers weight loss surgery. To qualify for coverage of weight loss surgery, your policy must include coverage. Please note that not all policies include coverage. So, to find out if your policy includes coverage, please talk directly to Blue Cross Blue Shield Nebraska.

Blue Cross Blue Shield Nebraska Pre-Approval Requirements

To be approved for coverage of weight loss surgery, the patient has to meet the following criteria:

  • The BCBSNE policy has been endorsed for weight loss surgery. This basically means that the individual policy contains coverage.  In case there is no endorsement, the patient will not be considered for weight loss surgery coverage.
  • The patient has to be at least 16 years old at the time of applying for coverage.
  • The Body Mass Index (BMI) of the patient should be over 40. Patients with a BMI of 35 to 40 will also be considered for weight loss surgery coverage provided they are suffering from a co-morbid condition.
  • The patient’s BMI should have been above 30 for more than five years.
  • Cases will be considered if there is no clear-cut treatable medical cause for the morbid obesity.

Types of Weight Loss Surgeries Covered By Blue Cross Blue Shield Nebraska

Not every weight loss procedure is covered by BCBS of Nebraska. Weight loss procedures that have been scientifically validated are covered by your BCBSNE policy. They include:

Advertisement
Advertisement

All these procedures can and, if possible, should be performed laparoscopically.

Procedures Excluded From Coverage

Any procedure that lacks authentic scientific validation is excluded from coverage. These procedures are considered experimental and investigative and do not guarantee results. They include Biliopancreatic Bypass without a Duodenal Switch.

Is A Second Weight Loss Surgery Covered If Lap Band Doesn’t Work?

Blue Cross Blue Shield policies generally provide coverage for a second weight loss surgery if lap band doesn’t work as long as it’s considered medically necessary. No specific information regarding this is available from Blue Cross Blue Shield Nebraska. Therefore, please talk directly to Blue Cross Blue Shield Nebraska to find out more information regarding reoperation.

Revisions

Revisions are allowed under your BCBSNE plan in case either of the following two situations arises:

  • Inadequate weight loss after the procedure.
  • Complications related to the surgery

Does Blue Cross Blue Shield Nebraska Require A Center Of Excellence?

No information is available regarding the surgery being performed at a Center of Excellence. Blue Cross Blue Shield plans vary from state to state. Some BCBS plans do require surgery be performed at a Blue Distinction Center. So please inquire directly from Blue Cross Blue Shield Nebraska.

Do I Have To Use An In-Network Bariatric Surgeon?

No, Blue Cross Blue Shield of Nebraska does not make it compulsory for patients to use an in-network bariatric surgeon. However, the costs of the procedure are lower when using an in-network bariatric surgeon.

Policy Of Coverage

To view Blue Cross Blue Shield of Nebraska’s policy regarding surgery for morbid obesity, visit page 11 of this document

Blue Cross Blue Shield Nebraska Contact Info to Inquire About Surgery

The customer service number for Blue Cross Blue Shield Nebraska is 1-888-592-8961. You can also get in touch with them online through the official website.

Advertisement

Share this Post