If your BMI is below 40, Aetna will also evaluate your weight-related medical conditions prior to granting authorization for a LAP-BAND Surgery. In some cases, you may be required to undergo a nutritional evaluation, which involves a supervised three month diet. Most of the time, Aetna will indeed cover your weight loss surgery should you meet your plan’s requirements, such as having a Body Mass Index (BMI) of 35 or greater. Aetna Weight Loss Surgery CoverageĪetna’s coverage depends on the insurance plan of each individual, as well as each patient’s ability to meet the criteria for bariatric coverage. To find out if your individual Blue Cross Blue Shield Plan covers the weight loss surgery, call us at (310) 855-8058 or fill out our Free Insurance Verification Form for weight loss and one of our helpful staff members will contact you within a couple of hours with your list of benefits. If Your BMI is below 40, Blue Cross Shield will also evaluate your weight-related medical conditions prior to granting authorization for a LAP-BAND Surgery. In some cases, you may be required to undergo a nutritional evaluation, which involves a supervised 6-12 month nonsurgical weight-loss regime. Most of the time, Blue Cross Blue Shield will indeed cover your weight loss surgery should you meet your plan’s requirements, such as having a Body Mass Index (BMI) of 35 or greater. BCBS has thirty nine locally operated companies, so each plan may vary. If you do not automatically qualify for coverage, one of our helpful staff members will assist you in identifying your best options.īlue Cross Blue Shield’s coverage depends on the insurance plan of each individual, as well as each patient’s ability to meet the criteria for bariatric coverage. We offer Free Insurance Verification as a quick, easy way to find out if your insurance will cover you for weight loss Surgery. TennCare can be contacted on the TennCare website.If you meet your insurance plan’s criteria for bariatric coverage, Blue Cross Blue Shield will most likely cover your weight loss Surgery. TennCare contact information to inquire about surgery Which procedure is right for you? Do I have to use an in-network Bariatric Surgeon?įor revisions you will need to use a TennCare approved surgeon. Procedures outside of the covered list are considered experimental and therefore not covered by TennCare. What procedures are excluded from coverage? Lap gastric band fills are covered as necessary to maintain weight loss after your procedure. Types of weight loss surgeries covered by TennCare Patient’s that are part of TennCare AmeriGroup may also require blood work, clearance from a cardiologist and/or pulmonologist and a nutritional evaluation. A letter recommending weight loss surgery from your primary care physician.This must be documented and it should have occurred within the last two years prior to surgery. Participation in a medically supervised weight loss program. This is usually obtained from doctors visits such as your annual physical exam.A documented history of being morbidly obese for at least 5 years.OR a body mass index of 35 and greater with at least 2 comorbidities that may include:.TennCare’s pre-approval requirementsįor TennCare to cover your weight loss surgery the following are required: In 2011 TennCare adopted the guidelines that Blue Cross Blue Shield uses for bariatric surgery. TennCare does cover weight loss surgery for those individuals that meet certain criteria. To find out if you policy includes coverage, please talk directly to TennCare. To qualify for coverage of weight loss surgery, your policy must include coverage.
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