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Common Insurance Requirements
for Surgical Treatment for Morbid Obesity
NOTE: WE ACCEPT MANY MORE INSURANCE PLANS THAN ARE LISTED BELOW, THESE ARE COMPANIES THAT HAVE SPECIFIC REQUIREMENTS THAT WILL NEED TO BE MET FOR APPROVAL OF WEIGHT LOSS SURGERY. PLEASE CALL US IF YOU HAVE QUESTIONS ABOUT YOUR INSURANCE PLAN.

Universal Treatment Requirements
NIH criteria for surgical treatment of obesity:
BMI > 40 (80-100lbs overweight)
BMI > 35 with presence of severe co-morbid conditions such as diabetes, GERD, hypertension

United Healthcare (all plans)
Subject only to plan limitations and universal treatement requirements.

Aetna US Healthcare (all plans)
WE ARE NO LONGER ACCEPTING NEW AETNA PATIENTS

CIGNA (all plans)
NOTE: CIGNA DOES NOT COVER LAP-BANDS
®
Legible documentation from physician supervising at least three non-surgical weight loss attempts within the past five years; one of which has to have been in the past 12 months and at least 6 months in duration. Documentation should include name of therapy, duration of therapy, and notes about the progress including at least monthly weigh-ins. Recent trial must also include evaluation by a licensced dietitian. NOTE: A physician's summary letter is not sufficient documentation - the records must be in the patient's chart notes.
Psychiatric Evaluation
Care plan for long-term follow-up. (Provided by surgeon)

Pacific Life (all plans)
Five year documented (in patient record) history of morbid obesity
Psychiatric evaluation
Dietitian consultation and evaluation
Documentation of previous weight loss attempts
Documentation of a 12 week, physician-supervised weight loss attempt, having taken place within the previous 12 months

Unicare (all plans)
Listing of all previous non-surgical therapies for weight loss.
Demonstration of psychological readiness for procedure. (psychiatric evaluation)
Medical clearance from primary care physician or internal medicine specialist.
Evaluation for diabetes/ endocrine disorders by endocrinologist
Care plan for long-term follow-up. (Provided by physician)
WILL NOT COVER LONG-LIMB (>100cm) BYPASS, WILL NOT COVER LAP-BANDS®

One Health (all plans)
Listing of all previous non-surgical therapies for weight loss.
Demonstration of psychological readiness for procedure. (psychiatric evaluation)
Medical clearance from primary care physician or internal medicine specialist.
Evaluation for diabetes/ endocrine disorders by endocrinologist
Care plan for long-term follow-up. (Provided by surgeon)

Blue Cross/ Blue Shield
WE ARE OUT OF NETWORK ON BC/BS PLANS.
HMO PLANS WILL NOT OFFER BENEFITS FOR OBESITY SURGERY
DEPOSIT WILL BE REQUIRED IN ADVANCE OF SURGERY

Pacificare (all plans)
WE ARE NO LONGER ACCEPTING NEW PACIFICARE PATIENTS

Humana (all plans)
Requirements vary on a case-by case basis.

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