Gastric Bypass Insurance
Details on what kind of insurance coverage you can get on gastric bypass surgery.
Gastric bypass is an operation to cure morbid obesity. This operation is covered by insurance companies which offer help and support to those people who fit their requirements. Each insurance company and each type of insurance has its own requirements for a patient to fulfill before being given the insurance to have the procedure down. While you may be looking at one policy, an insurance company may opt to give you a different kind, depending on which policy would cater to you more. Here are some of the insurance policies in gastric bypass given by the insurance company along with their requirements for patients.
In Medicare, where the per policy bulletin S-131A states that the patient is required to have a BMI of over 35 and a minimum of two years condition of morbid obesity. Before the surgery, a 3-month multi-disciplinary diet, exercise and behavior modification will be monitored by a physician or by psychiatrist evaluation.
Next is Cigna where the per policy bulletin 0051 insurance requires 6 months of diet where the patient is supervised by primary care physician, a medical evaluation by primary care physician and the patient’s history from the past two years.
The First Health where the per faxed policy insurance requires 3 months of multi-disciplinary diet approach, psych evaluation, pulmonary evaluation, cardiac evaluation and. Also, this insurance covers a post op program.
The Humana where the per policy bulletin insurance requires 6 months of diet which is medically supervised, a primary care physician clearance and psych evaluation.
The Unicare per policy bulletin SURG 00024 insurance requires a completion of attachment, depth diet consult, compliance letter and a psych evaluation.
Lastly is the Blue Cross where it is divided into several groups. The Blue Cross Anthem where their per policy bulletin SURG.00024 requires the same as the Unicare but the policy is different in every region. The Blue Cross National CareFirst is different where their per policy bulletin 7.01.036 insurance requires a psych clearance and a 3-month diet. Another Blue Cross is from Alabama where their per policy bulletin 053 insurance requires 6 months of diet , three years of medical documentation, and patients who are morbidly obese. Another is the Blue cross of Arkansas in which per policy bulletin 1998118 insurance requires for a patient to have a body mass index of over 36 and failed structure weight for loss program.
Insurance companies are pretty strict as they study each gastric bypass patient’s case to know where and which policy you may fit into. However, there may also be some cases where patients are excluded in the policy. If the patient has an exclusion case, the patient should look for another policy that would cover for the gastric bypass. The worst case scenario is that you would have to pay for your own procedure.
