Your Blue Cross Blue Shield Texas weight loss surgery insurance coverage depends on several factors, all of which are reviewed below. To request a free insurance check, click here to contact a local surgeon. Alternatively, use the tool below to find out if you have coverage. Read and click below for additional weight loss surgery
insurance details. Click on any of the topics below to jump directly to that section
SECTION SUMMARY: READ THIS FIRSTEven if your insurance company covers bariatric surgery in some plans, that does not mean that your specific plan covers it. The obesity surgery approval requirements in this section assume that weight loss surgery is covered by your specific policy. To confirm whether your specific policiy covers bariatric surgery, click here to contact a surgeon and ask for a free insurance check. Disclaimer: The information contained on this page may not include all components of your insurance company’s medical policy and/or may not be up to date. Contact your insurance company to confirm all benefits. In order to be approved by Blue Cross Blue Shield Texas for bariatric surgery in the United States, you must meet the following criteria:
Or Use this BMI Calculator to check your body mass index… Revision Requirements
If Your Policy Does NOT Cover It: Seek Partial CoverageYou may be able to get part of the costs paid for by insurance even if weight loss surgery isn’t covered. It’s all about how your doctor and hospital submit your claims to your insurance company. For example, there are many non-bariatric surgery reasons for your doctor to recommend:
These are ordered for many reasons other than bariatric surgery and may be covered as a result. If your doctor submits one of these claims using a weight loss surgery CPT code (Current Procedural Terminology Code), your insurance is unlikely to cover it. But if your doctor uses a general CPT code, it probably will be covered. While this may sound “sneaky”, it is an ethical practice. After all, these tests will be beneficial regardless of whether you move forward with surgery. Contact Blue Cross Blue Shield Texas to Ask About Bariatric Surgery
SECTION SUMMARY:
Before getting into the types of insurance plans, you can cut to the chase by contacting a local bariatric surgeon’s office. Most surgeons will contact your insurance company for free to confirm whether or not you’re covered. Click here to find a local surgeon and ask them to check your insurance for you for free. Blue Cross Blue Shield Texas does cover weight loss surgery, but your specific policy must include it in order for you get it covered. Following are a list of Blue Cross Blue Shield Texas plan types and whether they cover bariatric surgery: Weight Loss Surgery for Health Plans Through Your WorkIf you work for a company that has 50 or more full time employees, it is completely up to your employer to decide whether or not to cover bariatric surgery under your health plan. To find out whether weight loss surgery is covered by your employer’s plan, you have a few options:
Weight Loss Surgery for Individual/Family PlansThe Affordable Care Act (Obamacare) requires all individual and small group plans (less than 50 full time employees) to include weight loss surgery coverage as long as it is considered an “Essential Health Benefit” in your state. The following states DO currently consider bariatric surgery an Essential Health Benefit (bariatric surgery is covered by all individual, family and small group plans in these states): Your State Not on the List?If your state is NOT on the list, then weight loss surgery is probably NOT covered under your plan. First, contact your local surgeon to be sure. For no charge, their office will contact your insurance company on your behalf to work through the details. If your surgeon confirms that your policy does not include obesity surgery, you still have several options for making surgery more affordable. See these pages for more information:
Regardless of whether your state is on the list, contact a qualified surgeon to request a free insurance check to verify your coverage. To review your insurance company’s obesity surgery coverage requirements, click here to jump back up the page. Weight Loss Surgery for Medicare PlansAll Medicare plans are required to cover the following weight loss surgery procedures:
However, special Medicare-specific criteria apply. Click here to learn more about Medicare bariatric surgery coverage. 03. Covered Weight Loss ProceduresSECTION SUMMARY:
Please see below for the procedures Blue Cross Blue Shield Texas covers, might cover under certain circumstances, and those that are not covered under any circumstances: Procedures That ARE Covered
Procedures That MIGHT BE CoveredThe following procedures MIGHT BE covered by Blue Cross Blue Shield Texas:
Procedures That Are NOT CoveredThe following procedures are NOT covered by Blue Cross Blue Shield Texas:
SECTION SUMMARY:
If Blue Cross Blue Shield Texas denies your weight loss surgery claim and you think it should be covered, consider filing an appeal. Our Health Insurance Appeals page will get you started, then head over to the Disputes & Appeals page for Blue Cross Blue Shield Texas to learn how to proceed. 05. Find A Top Weight Loss SurgeonSECTION SUMMARY:
Search the weight loss surgeon directory below to ask a surgeon about a free insurance check by country and region: * Disclaimers: Content: The information contained in this website is provided for general information purposes and your specific results may vary depending on a variety of circumstances. It is not intended as nor should be relied upon as medical advice. Rather, it is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her existing physician(s). Before you use any of the information provided in the site, you should seek the advice of a qualified medical, dietary, fitness or other appropriate professional. Advertising: Bariatric Surgery Source, LLC has entered into referral and advertising arrangements with certain medical practices, original equipment manufacturers, and financial companies under which we receive compensation (in the form of flat fees per qualifying action) when you click on links to our partners and/or submit information. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. Read More Request a Free Insurance CheckFill out the below form for a free insurance check performed in partnership with your local bariatric surgeon. Advertisement Los Angeles/Orange CountyHow much weight do you have to lose before gastric sleeve?Some patients are required to lose 10 percent of their weight before weight-loss surgery is performed. For other patients, losing just 15 to 20 pounds right before surgery is enough to reduce the risk of complications. It's important to follow your surgeon's pre-surgery diet and nutrition guidelines.
Do you lose more weight with bypass or sleeve?Gastric bypass patients lose between 50 to 80 percent of excess bodyweight within 12 to 18 months, on average. Gastric sleeve patients lose between 60 and 70 percent of their excess body weight within 12 to 18 months, on average.
Is gastric sleeve surgery painful?While pain sensitivity varies among patients, most of our patients report minimal pain several hours after surgery and take almost no pain medications on the following day.
What is the success rate of gastric sleeve surgery?One of the first things that makes the gastric sleeve so popular is its excellent success rate, which is between 80% and 90%. On average, people who undergo this weight loss surgery lose 60-70% of their excess weight within one year.
Do I qualify for weight loss surgery in NY?Patient Requirements
Body mass index (BMI)—You must have a body mass index greater than 40, or greater than 35 plus one or more weight-related health problems such as diabetes, hypertension (high blood pressure), high cholesterol, or sleep apnea.
Does Blue Cross Blue Shield Texas cover Panniculectomy?The answer is no.
|