Insurance Coverage at the "Big Orange Box"

from their manual: coverage for services and surgical procedures

related to obesity will need to be reviewed for

medical necessity before the claims administrator

can determine if benefits are payable. There

must be presence of morbid obesity, defined as

a body mass index exceeding 40, or greater

than 35 in conjunction with severe co-morbidity’s

such as cardiopulmonary complications, severe

diabetes or documented history of repeated

failure of physician-supervised medical/dietary

therapies. Covered treatments include routine

cholecystectomy in concert with elective bariatric

procedures, bariatric surgery, gastric restrictive,

gastric bypass, gastroplasty (vertical banded)

and revision of gastric restrictive or bypass

surgery that has failed due to dilation of the gastric

pouch (if the original procedures resulted in

weight loss prior to the pouch dilation). Non-covered

treatments include procedures reviewed as

unsafe or inadequate, loop gastric bypass,

biliopancreatic bypass, gastroplasty using staples

to create a small pouch, a duodenal switch

operation and laparoscopic adjustable silicone

gastric banding using the LAP band.