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.
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