BCBS Alabama does cover weight loss surgery as long as your policy does not exclude coverage. ObesityCoverage strongly feels that morbid obesity is a disease and every insurance company should cover these life saving procedures. So we are happy to report that BCBS Alabama covers weight loss surgery. In fact, most of the Blue Cross Blue Shield network has some sort of coverage for weight loss surgeries.
It is important to know that your employer can opt-out of weight loss surgery insurance coverage for their employees policies. This typically saves the company money on their premiums. Contact information for BCBS Alabama is listed below. Even if your policy specifically excludes weight loss surgery, because BCBS has shown that these types of surgeries are medically necessary you might be able to appeal their exclusion. Before calling make sure you see our questions to ask before calling your insurance company section.
BCBS Alabama Pre-Approval Requirements
The items below are the minimum necessary for approval of your weight loss surgery.
- Body Mass Index (BMI) of 40 or greater OR…
- BMI 35 or greater with a co-morbid conditions, including but not limited to HTN on optimal drug therapy, cardiovascular disease, diabetes (must be treated with insulin or oral agents), pulmonary hypertension or severe obstructive sleep apnea (RDI of 50 or greater).
- Documentation of participation in a physician supervised program of nutrition and increased activity including dietitian consultation, low calorie diet, increased physical activity and behavioral modification. Program must be for six consecutive months and must be within previous 12 months of request for surgery. Documentation of program participation must appear in the medical record by the attending physician. Records must include comments by the physician regarding patient progress or lack of progress OR acceptable with medical record documentation of medical supervision are: Weight Watchers, LA Weight Loss, Jenny Craig, EatRight etc. Not acceptable are self-directed programs such as joining a gym, Atkins diet, calorie counting, low fat, cutting back, internet programs, etc.
- Active participation and documentation of non-surgical methods of weight loss.
- Diagnosed as morbidly obese for 3 years or more in medical records. A letter from the PCP and dated photographs will be considered in lieu of recorded heights and weights.
- 18 years of age
- Primary Care Physicians Letter (PCP Letter)
- Consult and Recommendation for surgeon from bariatric surgeon.
- Must stop smoking at least 8 weeks prior to surgery.
If you have not started gathering your medical history we suggest, contacting your primary care physician, ObGyn, and other physicians that have medical records.
Types of Weight Loss Surgeries Covered By BCBS Alabama
Recently gastric sleeves have begun to be covered by some of the large insurance companies as a primary weight loss surgery.
Covered Weight Loss Surgery Procedures
- Laparoscopic Gastric Bypass
- Open Gastric Bypass Surgery
- Gastric Banding – including the Lap Band and Realize Band
Lap Band Fills Covered?
BCBS Alabama considers Lap Band fills a Medical Necessity when required to meet the proper level of weight loss. This is true only if you’ve had a previous adjustable gastric banding procedure that met all of the criteria laid out for that procedure. Typically, if you paid cash for the procedure ongoing lap band fills will not be covered by insurance.
Procedures Excluded From Coverage
- Gastric Sleeve
- Mini-Gastric Bypass
Is a Second Weight Loss Surgery Covered if Gastric Banding Didn’t Work?
We are currently looking into this. If you have information, please email us.
- Revisions are covered if there is documentation of a failure secondary to a surgical complication. Complications can include but are not limited to fistula, obstruction or disruption of a suture/staple line.
Does BCBS Alabama Require Center Of Excellence?
Although we didn’t find it stipulated most of BCBS requires your weight loss surgery to be performed at a Center of Excellence.
Do I have to use an in-network weight loss surgeon?
No. However, your deductible and out of pocket costs may be significantly lower if you do. And you will still need to find a surgeon that has privileges to perform the surgery at a accredited Center Of Excellence for Bariatric Surgery.
BCBS Alabama Contact Info to Inquire About Surgery
BCBS Alabama’s contact information.
While BCBS Alabama doesn’t publish their full weight loss surgery policy, this provides an excellent resource.
This post was last modified on January 16, 2015 6:43 pm