Blue Cross Blue Shield of Minnesota 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. To find out if your policy includes coverage, please talk directly to Blue Cross Blue Shield of Minnesota.
Blue Cross Blue Shield Minnesota’s Pre-Approval Requirements
Patients suffering from morbid obesity will be approved for surgery upon meeting the following requirements.
- The surgery has to be considered medically necessary.
- The patient should be over 18 years of age at the time of the approval.
- The Body Mass Index (BMI) of the patient should be above 40. Patients with a BMI between 35 and 40 will also be considered for coverage if they suffer from any co-morbid condition, such as:
- Cardiovascular health problems
- Diabetes
- Sleep apnea
- Degenerative joint disease
- Asthma
- The patient should have been morbidly obese for a period of at least two years before the surgery and over two years in all. The two-year stipulation might be waived if the patient loses weight through any other method during this period. He/she will not be asked to start over.
- The patient should have been part of a non-surgical weight loss program during the one-year period before the surgery but without success. The minimum participation should have been three consecutive months.
- A mental analysis of the patient should be done by a licensed and qualified practitioner. The purpose of this is to determine if the patient is mentally sound enough to understand the procedure and the post-operative recommendations.
- The surgeon should check for the following components:
- Diet plan to follow before and after the surgery
- Strategies to deal with changes in behavior after the procedure
- Instructions for the patient to be more physically active and exercise after the surgery
- Support provided to help the patient cope with lifestyle changes
The authorization for the procedure will be granted when the physician has checked and approved the components listed above.
All of these requirements have to be met in order for a patient to be covered for the surgery.
Types of Weight Loss Surgeries Covered by Blue Cross Blue Shield Minnesota
The procedures covered by Blue Cross Blue Shield Minnesota are considered medically necessary. They include:
- Open Vertical Banded Gastroplasty
- Open Gastric Bypass
- Laparoscopic Gastric Bypass
- Open/Laparoscopic Sleeve Gastrectomy
- Adjustable Gastric Banding
- Open/Laparoscopic Biliopancreatic Bypass
Procedures Excluded from Coverage
The procedures considered investigative are excluded from coverage. They include:
- Biliopancreatic Bypass without Duodenal Switch
- Bariatric Surgery for Curing Diabetes
- Long-limb Gastric Bypass
- Laparoscopic Vertical Banded Gastroplasty
- Endoluminal Procedure
- Mini-Gastric Bypass
Is a Second Weight Loss Surgery Covered If Lap Band Doesn’t Work?
Yes, but only if considered medically necessary.
Revisions
Revisions are covered if considered medically necessary. The procedure will be performed to:
- Treat complications arising from the original surgery.
- Inspect inadequate weight loss after the procedure. This requires:
- Documentation proving that the patient followed the exercise and dietary guidelines
- The patient’s BMI is at the level outlined in the criteria
- Two years have passed since the surgery
Does Blue Cross Blue Shield Minnesota Require a Center of Excellence?
No, Blue Cross Blue Shield Minnesota does not require a Center of Excellence, but most BCBS plans do.
Do I Have To Use An In-Network Bariatric Surgeon?
No, you don’t have to use an in-network bariatric surgeon, though the costs will be lower if you do.
Full Policy
You can review BCBS of Minnesota’s full policy on weight loss surgery here (page 2).
Contact BCBS of Minnesota
Members can contact BCBS of Minnesota here.