List of Insurance Companies with their Bariatric Surgery Qualification Requirements

The following page is a general guideline for insurance requirements for weight loss surgery.  Insurance coverage varies depending on your policy.  It is best to check with your insurance carrier directly to get detailed information as to what is required to qualify for bariatric surgery.

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Aetna: Patients must be severely obese for at least 2 years; have participated in a physician-supervised exercise and nutrition program for at least 3 months (must be documented in patient’s medical records); behavior modification treatment and a psychiatric evaluation if medically indicated.  

Check your Aetna Insurance Policy for bariatric coverage

Anthem Blue Cross: Psychiatric consultation and one dietary consultation must be documented.

Check your Anthem Blue Cross Insurance Policy for bariatric coverage

Blue Cross Federal: Patient must have a BMI or more than 40, or a BMI of 35-40 plus a weight-related medical condition that is currently being treated. Gastric sleeve is covered.

Check your Blue Cross Federal Insurance Policy for bariatric coverage

Blue Cross National CareFirst: Insurance coverage requires a psychiatric evaluation and clearance, and demonstration of a completed 6-month diet plan (or 2 three-month diets). Gastric sleeve is covered.

Check your Blue Cross National CareFirst Insurance Policy for bariatric coverage

Blue Cross of Alabama: Requires 6 months of a physician-supervised exercise and nutrition program, plus increased physical activity; 3 years of medically documented morbid obesity, and H&P by bariatric surgeon. Must participate in programs such as Weight Watchers, LA Weight Loss or Eat Right, and have medical documentation of results; gastric sleeve is investigational and not covered.

Check your Blue Cross of Alabama Insurance Policy for bariatric coverage

Blue Cross of Arkansas: Insurance requires patient to have a BMI of more than 36 and demonstration of a failed, structured weight loss program participation. Gastric sleeve is covered if BMI is more than 60, with cardiac or pulmonary problems.  

Check your Blue Cross of Arkansas Insurance Policy for bariatric coverage

Blue Cross of California: Lifestyle and dietary changes are the first treatment for morbid obesity. Bariatric surgery should be reserved for patients for whom all other methods of treatment have failed. Gastric Sleeve is investigational and not covered. 

Check your Blue Cross of California Insurance Policy for bariatric coverage

Blue Cross Blue Shield of Delaware: Insurance coverage requires LOMN, clearance of cardiac and pulmonary systems, and sleep apnea work-up.

Check your Blue Cross Blue Shield of Delaware Insurance Policy for bariatric coverage

Blue Cross Blue Shield of Florida: Insurance coverage requires a 5-year medical history; 6-month diet program; psychiatric evaluation; and TSH that shows no endocrine disorders. Gastric sleeve is covered.

Check your Blue Cross Blue Shield of Florida Insurance Policy for bariatric coverage

Blue Cross Blue Shield of Georgia: Insurance requires one diet consultation with a history of the patient’s previous weight loss attempts; a psychiatric evaluation; a compliance letter from the patient; a treatment plan; and Attachment A. Gastric sleeve is investigational and not covered.

Check your Blue Cross Blue Shield of Georgia Insurance Policy for bariatric coverage

Blue Cross Blue Shield of Illinois: Insurance requires 5-year medical history, 6-month diet plan, psychiatric evaluation, and a letter showing willingness to comply. Gastric sleeve and StomaphyX are investigational and not covered.

Check your Blue Cross of Illinois Insurance Policy for bariatric coverage

Blue Cross Blue Shield of Massachusetts: Insurance requires one diet consultation with a history of previous weight loss attempts. Gastric sleeve is not covered.

Blue Cross Blue Shield of Michigan: Insurance requires medically supervised 12-month diet and evidence of failure, PCP clearance and psychiatric evaluation. Gastric sleeve is not covered.

Check your Blue Cross of Michigan Insurance Policy for bariatric coverage

Blue Cross Blue Shield of Minnesota: Insurance requires a 2-year history of morbid obesity, evidence of 6-month diet failure, psychiatric evaluation, and a compliance letter. Commercial weight loss programs not covered. Gastric sleeve may be considered for patients with a BMI of more than 50 plus a severe weight-related medical problem.  

Blue Cross Blue Shield of Mississippi: Insurance requires 5-year history of morbid obesity and documentation of failed diet attempts. Gastric sleeve is investigational and not covered.

Blue Cross Blue Shield of Nebraska: Insurance requires 5-year history, no treatable medical cause for obesity, and the patient must be over age 16. Gastric sleeve is investigational and not covered.

Blue Cross Blue Shield of New Mexico: Before determining coverage for surgical treatment of obesity, conservative treatment options must have been tried and have failed. The condition of morbid/clinically severe obesity must be of at least 5 years duration, Non-surgical methods of weight reduction must have been unsuccessfully attempted for at least 5 years under physician supervision. 

Blue Cross Blue Shield of North Carolina: Patient must have undergone a thorough evaluation, documented to assess suitability for surgery and their ability to comply with lifelong follow up. Five-year history required, a 6-month diet, and psychiatric evaluation. 

Check your Blue Cross Blue Shield of North Carolina Insurance Policy for bariatric coverage

Blue Cross Blue Shield of North Dakota: Insurance requires physician documentation of weight loss measures taken over the past 5 years, 3-year weight history and a psychiatric  evaluation. Limited to one procedure per lifetime. Gastric sleeve is investigational and not covered.

Blue Cross Blue Shield of Oklahoma: Insurance requires a 5-year history, a 6-month diet program, a psychiatric evaluation, and a compliance letter from the patient. Gastric sleeve is investigational and not covered.

Blue Cross Blue Shield of Tennessee: Insurance requires completion of the Pre-Bariatric Evaluation Tool, requests documentation of specific dates of diets, length of diets with successes and failures for past 2 years, PCP must document 10% weight loss, 5-year history and psychiatric evaluation. Gastric sleeve may be covered on case-by-case basis.  

Check your Blue Cross of Tennessee Insurance Policy for bariatric coverage

Blue Cross Blue Shield of Texas: Before determining the coverage for surgical treatment of obesity, conservative treatment options must have been tried and have failed. The condition of morbid/clinically severe obesity must be of at least 5 years duration, non-surgical methods of weight reduction must have been unsuccessfully attempted for at least 5 years under physician supervision. 

Check your Blue Cross Blue Shield of Texas Insurance Policy for bariatric coverage

Blue Shield of California: Insurance requires completion of Prior Authorization Review sheet, medical/surgical evaluation and clearance, psychiatric evaluation and one diet consult.

Check your Blue Cross of California Insurance Policy for bariatric coverage

Champ VA: Insurance requires BMI over 40 or BMI over 35 with an associated co-morbidity or surgical revision due to complications. Gastric sleeve is investigational and not covered.

Cigna: Pre-authorization required for treatment of patients who have been unsuccessful with diet and exercise and have acquired complications. 

Check your Cigna Insurance Policy for bariatric coverage

Empire Blue Cross: Insurance requires diet consult, exercise consult, TSH, psychiatric evaluation and attendance at support groups. Gastric sleeve is investigational and not covered.

Check your Empire Blue Cross Insurance Policy for bariatric coverage

Excellus Blue Cross: Insurance requires 5-year history, 6-month diet, TSH, documented 6-month abstinence from drugs/alcohol, and psychiatric evaluation. Gastric sleeve is investigational and not covered.

Check your Excellus Blue Cross Insurance Policy for bariatric coverage

First Health: Insurance requires 3-month multi-disciplinary diet approach, psychiatric evaluation, cardiac evaluation, pulmonary evaluation and post-op program.

Check your First Health Insurance Policy for bariatric coverage

Great West: See Cigna for requirements.

Health Scope Benefits: Insurance requires initial history and physical exam, along with office notes and any lab work done.

Check your Health Scope Benefits Insurance Policy for bariatric coverage

Horizon Blue Cross Blue Shield of New Jersey: Insurance requires 5-year history of morbid obesity, 6-month diet and exercise program, and psychiatric evaluation. Gastric sleeve is investigational and not covered.

Humana: Insurance requires 6-month medically supervised diet, primary care physician clearance, and psychiatric evaluation. Gastric sleeve is investigational and not covered.

Check your Humana Insurance Policy for bariatric coverage

Independence Blue Cross: Insurance requires medical clearance, psychiatric clearance and one time in-depth diet consultation. Gastric sleeve is investigational and not covered.

Kaiser Permanente: Insurance requires medical clearance, psychiatric clearance and one time in-depth diet consultation. 

Medicare: Insurance requires BMI of more than 35 with at least one co-morbid condition, minimum 2-year history of morbid obesity, 6-month PCP diet or 3-month multi-disciplinary diet, exercise and behavior modification program with neither supervised by the bariatric surgeon, and a psychiatric evaluation. It will not be covered when it is used to treat Type 2 diabetes in a beneficiary with a BMI below 35. Gastric sleeve is investigational and not covered.

Check your Medicare Insurance Policy for bariatric coverage

Pacificare Secure Horizons: Patient needs to have tried non-surgical treatment approaches including dietary counseling, exercise, behavior modification and support. Gastric surgery should generally be limited to patients with clinically severe obesity, a BMI of 40, or those with a BMI of 35 and who have significant medical co-morbidities.

Premera Blue Cross: Patient only requires form 14784 faxed in with letter of medical necessity and aftercare explanation letter. Gastric sleeve is investigational and not covered. 

Principal Financial Group: Insurance requires 3-year history, 6-month diet supervised by a physician other than a surgeon, and a psychiatric evaluation.

Regence Blue Shield: Insurance requires documentation of at least 6 months of active participation in a structured, medically supervised, non-surgical weight reduction program; including at least three visits for medical supervision and a psychiatric evaluation. Gastric sleeve is investigational and not covered.

Unicare: Insurance requires completion of Attachment, one in-depth diet consult, a psychiatric   evaluation and a compliance letter. Gastric sleeve is investigational and not covered. 

United Health Care: No set policy. Each case to be determined individually.

Check your United Health Care Insurance Policy for bariatric coverage

United Health Care THR: Patient has a $4,000 bariatric co-pay and must attend five months of a Healthy Weight program. Lap-Band surgery is not covered.

Wellmark Blue Cross Blue Shield: Insurance requires patient to have BMI of 40 or above, or a BMI greater than 35 along with documentation of 3 years or more with at least one obesity-related condition, documented failure of medically supervised weight loss for at least 6 months, and a psychological evaluation. Gastric sleeve is investigational and not covered.

Check your Wellmark Blue Cross Blue Shield Insurance Policy for bariatric coverage

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