
Will Blue Cross Blue Shield Cover Weight Loss Surgery?
A Comprehensive Guide to Coverage for Weight Loss Surgery
Yes, Blue Cross Blue Shield (BCBS) may cover weight loss surgery, but coverage can vary significantly by plan and state. Generally, BCBS recognizes weight loss surgery as a medically necessary treatment for obesity under certain conditions. To qualify for coverage, patients typically need to meet specific criteria, including a Body Mass Index (BMI) of 40 or higher, or a BMI of 35 with obesity-related health conditions. It's essential to check your specific plan details, as coverage can differ based on the employer or state regulations. In this guide, we will delve into the various aspects of BCBS coverage for weight loss surgery, including the types of surgeries that may be covered, the eligibility requirements, the claims process, and tips for ensuring your surgery is covered. Understanding these factors can help you navigate the often complex world of health insurance and make informed decisions about your weight loss journey.
Will Blue Cross Blue Shield Cover Weight Loss Surgery?
Blue Cross Blue Shield (BCBS) offers coverage for weight loss surgery, but the specifics can vary widely. Coverage is often contingent upon meeting certain medical criteria and obtaining prior authorization. Here’s a detailed look at what you need to know.
Types of Weight Loss Surgeries Covered
BCBS generally covers several types of weight loss surgeries, including:
- Gastric Bypass
- Gastric Sleeve
- Adjustable Gastric Banding
- Biliopancreatic Diversion with Duodenal Switch
Eligibility Criteria
To be eligible for coverage, patients typically must meet the following criteria:
- Have a BMI of 40 or higher, or a BMI of 35 with obesity-related health conditions.
- Have documented attempts at weight loss through diet and exercise.
- Be over the age of 18.
- Have a psychological evaluation to ensure readiness for surgery.
Claims Process
To ensure your surgery is covered, follow these steps:
Step-by-Step Claims Process
1. Consult with a healthcare provider to discuss weight loss surgery options.
2. Obtain a referral or recommendation for surgery.
3. Submit a pre-authorization request to BCBS with necessary medical documentation.
4. Wait for BCBS to approve or deny the request.
5. If approved, proceed with scheduling your surgery.
Pros and Cons of Weight Loss Surgery Coverage
Pros
- Can lead to significant weight loss and improved health outcomes.
- May cover necessary follow-up care and nutritional counseling.
Cons
- Not all plans cover the same procedures.
- Pre-authorization can be a lengthy process.
Quick Facts About BCBS Weight Loss Surgery Coverage
Quick Facts
Key Takeaways
- BCBS may cover weight loss surgery if medical criteria are met.
- Eligibility often requires a BMI of 40 or higher.
- Pre-authorization is a critical step in the claims process.
- Different BCBS plans have varying coverage details.
Frequently Asked Questions
What is the average out-of-pocket cost for weight loss surgery with BCBS?
The average out-of-pocket cost can range from $1,500 to $5,000 depending on your specific plan and deductible.
Are there any exclusions for weight loss surgery coverage?
Some plans may exclude certain types of surgeries or require additional documentation for coverage.
Can I appeal a denial for weight loss surgery coverage?
Yes, you can appeal a denial by submitting additional medical documentation and a formal appeal letter to BCBS.

Jaden Bohman is a researcher led writer and editor focused on productivity, technology, and evidence based workflows. Jaden blends academic rigor with real world testing to deliver clear, actionable advice readers can trust.
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