Yes...they cover...it is going to be a challenge to try to get BCBS to pay for the lapband. So, Ihave made a decision to try to self pay. Here is the policy:
SURGERY FOR MORBID OBESITY (cont.)
Criteria: (cont.)
A. Bariatric Surgery: (cont.)
Bariatric surgery is considered medically necessary with documentation of ALL of the following:
(cont.)
3. Diagnosis of morbid obesity for the past consecutive 5 years
4. Failure of non-surgical methods of weight loss with documentation of the following:
▪ Continuous participation in a weight loss program for 6 months or longer within the past 12
months. Weight loss program includes:
- A structured program that includes documentation of diet and dates of participation (a
minimum of one face-to-face visit per week attendance for dietary counseling/education
is required), and,
- A structured exercise program (unless medically contraindicated) designed and
supervised by a certified or qualified professional with documentation of attendance (a
minimum of three sessions per week of participation in an exercise program is required),
and,
- Demonstration of a commitment to results by documenting weight loss, maintenance, or
no more than a 5 pound weight gain over a minimum six month period
5. Pre-operative clinical assessment and documentation must reflect a significant motivation and
understanding of the risks associated with the intended surgery, as well as an understanding of
the life-long restricted eating habits that will follow.
6. Clinical documentation must reflect a plan for active participation in both a pre-surgical
instructional program AND a post-surgical, post-operative or follow-up program. Clinical
documentation must reflect participation in pre-operative nutritional counseling and that there is a
plan in place for post-operative nutritional counseling as well.
7. Individual is 18 years of age or older
8. Individual has no treatable condition that may be responsible for the morbid obesity, e.g.,
endocrine, metabolic, etc.
9. Individual has no significant liver, kidney or gastrointestinal disease
10. Individual has no drug or alcohol abuse – must be abstinent for 12 months or more if there is a
history of drug or alcohol abuse
I have most of it, except for the enrollment of a exercise program. I am unable to afford the gym card along with the 1000.00 access fee.