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Top 10 Unhealthy Fashion Trends. Per Clinical Policy Bulletin , all patients require 2 years documented medical history of morbid obesity, 3 months physician supervised non-surgical diet, exercise and behavior modification treatment and a psych evaluation if medically indicated. StomaphyX is experimental and not covered. Sleeve and StomaphyX are investigational and not covered. Blue Cross National CareFirst: Per Policy Bulletin 7. Gastric Sleeve is covered.
Blue Cross of Alabama: Blue Cross of Arkansas: Per Policy Bulletin insurance requires BMI over 36 and failed structured weight loss program. Blue Cross of California: Gastric Sleeve and StomaphyX are investigational and not covered. Blue Cross Blue Shield of Delaware: Insurance requires LOMN, cardiac, pulmonary and psych clearance and sleep apnea work-up. Blue Cross Blue Shield of Florida: Per Policy Bulletin insurance requires five-year history, 6 month diet, psych evaluation, and TSH showing no endocrine disorders.
Blue Cross Blue Shield of Georgia: Blue Cross Blue Shield of Illinois: Blue Cross of Blue Shield Massachusetts: Blue Cross Blue Shield of Michigan: Blue Cross Blue Shield of Minnesota: Blue Cross Blue Shield of Mississippi: Per Employee Access Policy Bulletin insurance requires five-year history of morbid obesity, documentation of failed diet attempts and TSH.
Blue Cross Blue Shield of Nebraska: Per Policy Bulletin 1. Per Corporate Medical Policy insurance requires physician documentation of weight loss measures over the past 5 years, three-year weight history and psych evaluation. Limited to one procedure per lifetime. Blue Cross Blue Shield of Oklahoma: Blue Cross Blue Shield of Tennessee: Gastric Sleeve may be covered on case by case determination.
StomaphyX is investigational and not covered. Blue Cross Blue Shield of Texas: Blue Shield of California: Per Policy Bulletin insurance requires 6 month diet supervised by Primary Care Physician or physician other than a bariatric surgeon , medical evaluation by PCP, psych evaluation and two year history. Per faxed policy insurance requires 3 month multi-disciplinary diet approach, psych evaluation, cardiac evaluation, pulmonary evaluation and post-op program.
Per faxed policy insurance requires initial history and physical exam with office notes and any lab work done Highmark Blue Cross: Per Policy Bulletin G insurance requires physician supervised 6 month diet and exercise program and psych evaluation. Per Policy Bulletin insurance requires five-year history of morbid obesity, 6 month diet and exercise program and psych evaluation.
Per Policy Bulletin insurance requires 6 month medically supervised diet, Primary Care Physician clearance and psych evaluation. Per Policy Bulletin Per Utilization Management at Pacificare, this is a general exclusion on the policy but should be submitted with LOMN, PCP, pulmonary, cardiac and psychiatric clearance along with three year history of diets tried and outcomes.