We have great news to all of you who have in your health insurance with BCBS and are considering a lap-band surgery. Starting February 2012, if your policy covers the treatment of morbid obesity, BCBS will no longer require six months of medically supervised diet to approve you for the lap-band surgery. The change in requirements will enable many patients to get their surgery when they are ready, instead of having to wait six months or more for the procedure. All of us on the DayOne Health team are very happy for everyone and wish you good luck on your weight loss journey.

What were the previous BCBS requirements for lap-band surgery coverage?

Depending on your policy, the requirements for approval may vary. Nevertheless, if your policy covers the treatment of morbid obesity, your insurance provider will most likely ask you to submit documentation for six months of a medically supervised diet and psychological evaluation in order to qualify. What this usually meant for our DayOne Health patients was that they had to meet with our dietitian and get weighted every month for six months prior to their procedure. With the new requirement in place, the length of time that the patient has to wait to get their band will shorten considerably.

What will be the new requirements?

Again, BCBS requirements for the approval of lap-band surgery may vary depending on your policy. However, most of the insurance companies, including BCBS, hold similar standards when it comes to approving bariatric procedures. The first requirement that is always in place when considering whether someone qualifies for coverage is a body mass index (BMI). For most insurance companies, including BCBS, the minimum BMI for approval is a BMI of 35 and above paired with two health conditions related to your weight, or a BMI of 40 and above with no additional requirements in terms of co-morbidities. Insurance companies also require a letter of medical necessity from the weight loss surgeon, as well as evaluations from a bariatric dietitian and psychologist.

How long on average does it take to get all the documentation needed?

With the BCBS changing its requirements, you will be able to obtain all the documentation needed for surgery approval within one to two days. At DayOne Health, you will be able to get most of your documentation ready during your first consultation with a surgeon. While the psychologist is not available here on site, DayOne Health is closely working with two psychologists that have their offices just a few blocks from our main office. In other words, with proper planning you’ll get everything you need to start the insurance approval process in one day. Following the submission of all documentation, it usually takes up to 30 days to hear whether the surgery was approved or not. At DayOne Health we try to make the whole process as easy as possible for our patients by taking care of most of the groundwork. However, if you have any questions considering your policy, coverage, approval, or appeal process, you can contact our insurance coordinator any time and discuss the best strategy.

If you have any questions considering our DayOne Health lap-band program or would like to speak to our insurance coordinator about your coverage call our Chicago clinic at (312) 239-3838.

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