Does Blue Shield Cover Weight Loss Surgery
Obesity is a major health concern in the United States. According to the Centers for Disease Control and Prevention (CDC), over 40 percent of adults in the United States are obese. Obesity can lead to a variety of health problems, including heart disease, diabetes, and high blood pressure.
For people who are struggling with obesity, weight loss surgery can be a life-changing option. However, weight loss surgery can be expensive, and not all insurance plans cover it. Blue Shield is one of the largest health insurance providers in the United States, so many people wonder if Blue Shield covers weight loss surgery.
Types of Weight Loss Surgery
There are several types of weight loss surgery, also known as bariatric surgery. The most common types of bariatric surgery are gastric bypass, gastric sleeve, and laparoscopic adjustable gastric banding.
Gastric bypass surgery involves dividing the stomach into two small pouches and rerouting the small intestine to the pouches. This reduces the size of the stomach and limits the amount of food that can be eaten at one time.
Gastric sleeve surgery involves removing a large portion of the stomach and creating a new, smaller stomach. This also limits the amount of food that can be eaten at one time.
Laparoscopic adjustable gastric banding involves placing an inflatable band around the top part of the stomach, which creates a small pouch. The band can be adjusted to control the size of the pouch and the amount of food that can be eaten.
Does Blue Shield Cover Weight Loss Surgery?
Blue Shield does cover weight loss surgery, but the coverage varies depending on the specific plan. In general, Blue Shield considers weight loss surgery to be a medically necessary procedure for people who have a body mass index (BMI) of 40 or higher, or a BMI of 35 or higher with at least one obesity-related health condition.
According to Blue Shield, the following weight loss procedures are covered:
- Gastric bypass
- Gastric sleeve
- Laparoscopic adjustable gastric banding
- Biliopancreatic diversion with duodenal switch
- Vertical banded gastroplasty
- Gastric plication
- Revisional bariatric surgery
In addition, Blue Shield may cover other weight loss services, such as nutritional counseling and exercise programs, as part of a comprehensive weight loss program.
How to Determine Coverage for Weight Loss Surgery
If you are considering weight loss surgery and have Blue Shield insurance, it is important to determine your coverage before proceeding with the procedure. To determine your coverage, you should follow these steps:
- Contact Blue Shield: The first step is to contact Blue Shield directly and ask about your coverage for weight loss surgery. You may need to provide information about your BMI and any obesity-related health conditions.
- Review Your Plan: Review your insurance plan documents carefully to determine what is covered and what is not covered. You may need to speak with a representative from Blue Shield to clarify any questions you have about your coverage.
- Get a Pre-Approval: Before undergoing weight loss surgery, your surgeon may need to obtain a pre-approval from Blue Shield to ensure that the procedure is covered.
- Check for Out-of-Pocket Costs: Even if weight loss surgery is covered by Blue Shield, you may still be responsible for some out-of-pocket costs, such as deductibles, copays, and coinsurance. Make sure you understand your financial responsibility before proceeding with the procedure.
Conclusion
Weight loss surgery can be an effective option for people who are struggling with obesity. Blue Shield does cover weight loss surgery, but the coverage varies depending on the specific plan. If you are considering weight loss surgery, it is important to determine your coverage and understand your financial responsibility before proceeding with the procedure.