Blue Cross Blue Shield Weight Loss Surgery

Blue Cross Blue Shield Weight Loss Surgery

Blue Cross Blue Shield Weight Loss Surgery

Blue Cross Blue Shield Weight Loss Surgery

 

Blue Cross Blue Shield of Minnesota – Weight Loss Surgery Coverage

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 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

secure from  https://www.obesitycoverage.com/blue-cross-blue-shield-of-minnesota-weight-loss-surgery-coverage/