Will anthem blue cross blue shield cover this surgery?

Question

lapband or/and gastric bypass

its the kentucky one, which i guess they are all pretty much the same

Answer 1

You have to check your specific policy.

Your employer/group selected a specific set of benefits, which may or may not have included gastric bypass.

Its not a matter of whether or not Anthem covers the surgery or not - they do cover the surgery. However, that doesn't mean that your employer group chose to have it offered as a covered benefit to you and your co-workers.

Answer 2

Impossible to answer specifically. Most plans do not cover it routinely - you'll have to jump thru hoops to get it covered - because it is a costly procedure and there's a lot of pre- and post-operative care involved.

What you need to do is call member services and they'll tell you what's specific to your plan. If it's not routinely covered, ask them what their procedure is about determining medical necessity, and what criteria they need. Some employers do not pick up this specific rider on the plan, in which case, you can't force them to pay for it. All you can do is ask.

I can tell you, 99% of plans won't even consider it for someone who isn't at least 100lbs overweight and/or in imminent life danger from being so obese. You also have to lose at least 5% of your body weight before you can even schedule the surgery. On the radio this morning, they had two leaders from a bariatric surgery support group on as guests who said that most people exploring the option of weight loss surgery often are the ones who need to lose less than 50 lbs - that's an automatic turn down.

Answer 3

Lapband/Gastic Bypass or any other type of bariatric surgeries are popular industry contract exclusions regardless of medical necessity.

Your rate of sucess will rise significantly in the HMO area and with larger group healthcare plans however; check your plan documentation.

Even when covered, there are massive hoops and hurdles to jump though to include nutrional counseling and a laundry list of other alternative surgical items.

Rule of thumb, obtain a pre-determination from the carrier. They usually have a muli-page document highlighting their pre-certification logic if it is covered under the medical plan.

Once again, this is a popular exclusion to policies.

Answer 4

Make pancakes even healthier with the addition of mashed baked sweet potato, several pureed spinach and blueberries, or maybe cooked quinoa.

Answer 5

I do not know that insurance company's rules, but weight loss surgery is typically covered only if it is for treatment of morbid obesity, not if it is for cosmetic purposes.

Answer 6

In general, most health insurance plans do not cover gastric surgery. I have BCBS in another state and they do not cover gastric surgery.

Answer 7

Aim for a 300- for you to 400-calorie meal.

Answer 8

You already know never to skip breakfast, but it's also crucial that you eat within an hour of waking to boost your metabolism.

Answer 9

You will have to check your policy and what benefits you purchased. You will (at the very least) have to have proof from your surgeon that it is a medical necessity and not cosmetic.

Answer 10

Keep cut-up fruits and veggies in the fridge to pick up for snacks or easy meals.