Blue Cross / Blue Shield Gastric Sleeve

Anthem Blue Cross Blue Shield Gastric Sleeve Coverage

Every person is different, and so is each insurance plan; Anthem Blue Cross and Blue Shield of California’s Gastric Sleeve Coverage and pre-approval requirements vary with every insurance policy and potential patient. Per the most recent Anthem Blue Cross Blue Shield Clinical Bulletin SURG.0024, Gastric Sleeve is now covered and available for those individuals who qualify.

Part of determining if Blue Cross or Blue Shield cover your gastric sleeve surgery is determining you have a Body Mass Index (BMI) of 35 or greater, along with obtaining a written letter detailing all prior attempts at weight loss programs, including diet and exercise, over the last 5 years. This may be required by Blue Cross or Blue Shield prior to covering any bariatric procedure. A diet and psychiatric evaluation are also required by Anthem Blue Cross Blue Shield in California. If your BMI is below 40, Anthem Blue Cross and Blue Shield will also consider all medical issues and problems related to your weight prior to authorizing coverage of your Gastric Sleeve Surgery. Depending on your Blue Shield or Blue Cross Gastric Sleeve Coverage, you may also be required to undergo 6 to 12 months of medically supervised, non-surgical attempts at weight reduction through nutrition, medication or maintenance therapy, behavior modification, exercise and increased activity.

It is also necessary for your physician requesting the coverage to fully explain the gastric sleeve surgery to you so that you completely understand the risks, benefits and how the procedure is performed. This also includes required dietary evaluations and nutritional counseling before and after your surgery to ensure maximum health and recovery.