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Tuesday, October 9, 2012

006 BCBS Pre-Approval Requirements

As I mentioned last post, we have Blue Cross/Blue Shield (BCBS) Insurance. I was going to tag all of this onto the last post and then I decided it would just be too much and more than a little overwhelming. Sorry to make you wait for it but rest assured that now you will get a more thorough answer to the insurance question.

Keep in mind that insurance coverage and requirements vary widely from one policy to the next. However, this is what Jimmy and I have been going through with BCBS. *Side note: I know that I haven’t mentioned this yet but we had considered WLS once before--about two years ago--and we had gone all the way through getting the insurance pre-approval before we backed out (due to circumstances beyond our control). So it was really nice to know basically what was going to be expected of us this time around which is why I think you will appreciate me sharing it with you*

The items below are the minimum necessary for approval of your weight loss surgery:
  • BMI of 40 or greater OR...
    a BMI of 35 or greater with at least 2 co-morbidities.
  • *A Co-Morbidity is a disease that has been caused by excessive weight. Diabetes is one of many examples.
  • Primary Care Physician’s Letter
  • Active Participation and Documentation of non-surgical methods of weight loss.
  • 6 consecutive months of a physician supervised weight loss program.
  • 18 years of age (special consideration if under 18 with severe morbid obesity and special circumstances).
  • Consult and recommendation from a weight loss surgeon.
  • Psychological evaluation
  • Nutritional evaluation

Policies Included in Coverage:
Blue cross Kentucky
Blue cross Virginia
Blue cross Wisconsin
Blue cross Ohio
Blue cross California
Blue cross Georgia
Blue cross Missouri
Blue cross New York Empire

Obviously this has all been a long time coming for us since we have had to undergo the six months of supervised weight loss. We will be talking more about this as time goes on, but now you have a better idea of what was required of us and what could possibly be required of you should you choose to pursue a WLS. Keep in mind that all insurance companies are different as is their coverage, but a good weight loss program/center/surgeon should help you collect and file all the insurance paperwork you need.

More Resources:


  1. I have BCBS of Minnesota and it's pretty much the same but keep in mind that not only will the insurance company have it's requirements but your surgeon's office may have it's own set of guidelines. At the Iowa Health Weight Loss Center in Des Moines I was also required to-
    1. Attend a seminar explaining all the types of bariatric surgeries before I could schedule an appointment.
    2. At the 1st appointment I met with the surgeon, the dietitian and was assigned an insurance liasion.
    3. Two evaluations by a psychologist.
    4. Cardiac clearance if you are over 50.
    5. Attend a support group meeting.
    My 1st step was the informational seminar on Feb. 3 of this year and I had my gastric sleeve procedure on Sept. 27. I feel wonderful and it's the best thing I have ever done for myself!

  2. NannyRuss, Thanks for reading! I posted a longer reply on your other post but I wanted to let you know that we really appreciate you and everyone else who has been reading and posting their experiences.

  3. What is "Jimmy goes gastric"'s BMI? If I may ask.

    1. You can definitely ask. Jimmy's BMI is currently just over 80.