Does Blue Shield Cover Gastric Sleeve Surgery?
Yes, Anthem Blue Cross and Blue Shield of California will cover your Gastric Sleeve Surgery as long as your insurance plan's requirements for bariatric surgery are met. Each Anthem Blue Cross and Blue Shield California insurance policy can vary on what weight management or bariatric and gastric surgery expenses are covered or excluded, so it may be easier to have our Gastric Sleeve Insurance Coordinators verify your Blue Cross or Blue Shield Gastric Sleeve Surgery coverage for you. Simply give us a call at 1-855-690-0559 or fill out our FREE Gastric Sleeve Insurance Verification Form. Verifying your Gastric Sleeve coverage is hassle-free with no obligation. Even if you don't meet your insurance policy's requirements, we can send a letter of medical necessity, request an individual need assessment and help you through the appeal process if necessary.
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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.
Blue Cross Blue Shield Gastric Sleeve Requirements
You may automatically pre-qualify for Blue Cross or Blue Shield to cover your Gastric Sleeve Surgery in California if:
- You are 100 pounds or more above ideal weight, or
- You have a Body Mass Index above 40, or
- You have a Body Mass Index of 35 or greater and suffer from medical problems associated with obesity such as coronary heart disease, type 2 diabetes, sleep apnea or hypertension.
- You have been overweight for at least five years, and
- You have been unsuccessful at all weight-loss attempts including diets, exercise and weight loss programs.
Blue Cross and Blue Shield is an association of independent, locally operated blue cross and blue shield plans collectively, providing health care coverage for more than 99 million people in the United States. Blue Cross and Blue Shield has a history spanning over 80 years and contracts with more than 90 percent of hospitals and 80 percent of physicians nationwide, offering services in California through Anthem Blue Cross and Blue Shield of California.
Other insurance carriers
- Does Aetna cover gastric sleeve?
- Does United Healthcare cover gastric sleeve?
- Does Cigna cover gastric sleeve?
- Does Humana cover gastric sleeve?
Disclaimer: This site is not affiliated with or endorsed by Blue Cross and/or Blue Shield and is for informational purposes only - The following Blue Cross and Blue Shield Gastric Sleeve guidelines have been compiled from various public sources. It is presented online for informational use only, and without warranty as to its accuracy, timeliness, or completeness. This site does not replace any official versions of the information presented, nor does inclusion on this list guarantee coverage. Please check your Blue Cross or Blue Shield policy before proceeding with your surgery.