Does BCBS cover the sleeve?
CHECK YOUR EXPLANATION OF BENEFITS PACKET UNDER BARIATRIC SERVICES. YOU CAN ALSO ACCESS YOUR EOB ON-LINE ON YOUR INSURANCE WEBSITE. IF IT STATES PRE-AUTHORIZATION REQUIRED, THEN CHANCES ARE IT IS. THERE WILL BE SOME REQUIREMENTS YOUR INSURANCE MAY HAVE YOU DO BEFORE SUBMITTING FOR AUTHORIZATION. TIME IS OF THE ESSENCE BECAUSE MOST INSURANCES REQUIRE A MEDICALLY SUPERVISED WEIGHT LOSS PROGRAM WHICH COULD BE AS SHORT AS 1 MONTH AND AS LONG AS A YEAR. SO IF YOUR CONSIDERING THE SLEEVE YOU MAY WANT TO START THIS WITH YOUR PCP. YOU CAN SEARCH BARIATRIC REQUIREMENTS FOR PRE-AUTHORIZATION ON THE SITE TOO. MY REQUIREMENTS WERE AS FOLLOWS:
-BMI OVER 40 WITHOUT COMMORBIDITIES OR 35-39.9 WITH AT LEAST ONE
-6 MONTH MEDICAL SUPERVISED WEIGHT LOSS PROGRAM (COVERED $45 COPAY/EA.)
-PSYCHIATRIC EVALUATION($45 COPAY)
-TWO YEARS OF MEDICAL DOCUMENTATION SHOWING BMI OVER 40(FREE UNLESS THEY CHARGE)
-NUTRITIONAL CONSULTATION (NOT COVERED $300)
-CONSULTATION WITH BARIATRIC SURGEON SHOWING MEDICAL NECESSITY($45 COPAY)
-MEDICAL CLEARANCE FROM PCP FOR SURGERY
ADDITIONAL CHARGES
$500 ANNUAL MEDICAL DEDUCTIBLE
$5000 ANNUAL OUT-OF-POCKET
PROTEIN SHAKES (NUT SAYS IT WILL COST ME AROUND $100/MONTH)
VITAMINS(VARIES)
HOPE THIS HELPS! LET ME KNOW IF THERE IS ANYTHING ELSE I CAN HELP YOU WITH
-BMI OVER 40 WITHOUT COMMORBIDITIES OR 35-39.9 WITH AT LEAST ONE
-6 MONTH MEDICAL SUPERVISED WEIGHT LOSS PROGRAM (COVERED $45 COPAY/EA.)
-PSYCHIATRIC EVALUATION($45 COPAY)
-TWO YEARS OF MEDICAL DOCUMENTATION SHOWING BMI OVER 40(FREE UNLESS THEY CHARGE)
-NUTRITIONAL CONSULTATION (NOT COVERED $300)
-CONSULTATION WITH BARIATRIC SURGEON SHOWING MEDICAL NECESSITY($45 COPAY)
-MEDICAL CLEARANCE FROM PCP FOR SURGERY
ADDITIONAL CHARGES
$500 ANNUAL MEDICAL DEDUCTIBLE
$5000 ANNUAL OUT-OF-POCKET
PROTEIN SHAKES (NUT SAYS IT WILL COST ME AROUND $100/MONTH)
VITAMINS(VARIES)
HOPE THIS HELPS! LET ME KNOW IF THERE IS ANYTHING ELSE I CAN HELP YOU WITH
Tough question. As the other commenter's said, there are a number of different independent BCBS providers and some coverage details are specified by your employer's plan.
That said, my BCBS did pay for my sleeve. If your policy covers weight loss surgery, most of the BCBS that I'm aware of now cover the sleeve. It's more a matter of whether they cover weight loss surgery at all.
Highest weight: 335 lbs, BMI 50.9
Pre-op weight: 319 lbs, BMI 48.5
Current range: 140-144, BMI 21.3 - 22
175+ lbs lost, maintaining since February 2012