Your Blue Cross Blue Shield of Montana weight loss surgery insurance coverage depends on several factors, all of which are reviewed below.
To request a free insurance check, click here to contact a local surgeon. Alternatively, use the tool below to find out if you have coverage.
Read and click below for additional weight loss surgery insurance details.
TABLE OF CONTENTS
Click on any of the topics below to jump directly to that section
- 35+ Body Mass Index (BMI)
- Documentation of failed diet attempts
- Psychological evaluation
READ THIS FIRST
Even if your insurance company covers bariatric surgery in some plans, that does not mean that your specific plan covers it. The obesity surgery approval requirements in this section assume that weight loss surgery is covered by your specific policy.
To confirm whether your specific policiy covers bariatric surgery, click here to contact a surgeon and ask for a free insurance check.
Disclaimer: The information contained on this page may not include all components of your insurance company’s medical policy and/or may not be up to date. Contact your insurance company to confirm all benefits.
In order to be approved by Blue Cross Blue Shield of Montana for bariatric surgery in the United States, you must meet the following criteria:
- Be of age 18 years or older
- Diagnosis of Morbid obesity, defined as
- a Body Mass Index (BMI) greater than 40
- BMI 35 – 39.9 AND one of the following
- Diabetes mellitus
- Coronary heart disease
- Sleep apnea
Use this BMI Calculator to check your body mass index…
- Nutrition program, which may include a very low calorie diet or a recognized commercial diet-based weight loss program
- Behavior modification or behavioral health interventions
- Counseling and instruction on exercise and increased physical activity
- Ongoing support for lifestyle changes to make and maintain appropriate choices that will reduce health risk factors and improve overall health
- The absence of significant psychopathology that would hinder the ability of an individual to understand the procedure and comply with medical/surgical recommendations
- The absence of any psychological comorbidity that could contribute to weight mismanagement or a diagnosed eating disorder
- The patient’s willingness to comply with preoperative and postoperative treatment plans
May be considered medically necessary only when ALL of the following criteria are met:
- Original surgery was considered a covered benefit of the member’s current plan, AND the repeat/revision of bariatric surgery is a covered benefit of the member’s current plan
- For the original procedure, patient met all the screening criteria, including BMI requirements
- The patient has been compliant with a prescribed nutrition and exercise program following the original surgery
- Significant complications or technical failure (e.g., break down of gastric pouch, slippage, breakage or erosion of gastric band, bowel obstruction, staple line failure, etc.) of the bariatric surgery has occurred that requires take down or revision of the original procedure that could only be addressed surgically
- Patient is requesting reinstitution of an acceptable bariatric surgical modality
If Your Policy Does NOT Cover It: Seek Partial Coverage
You may be able to get part of the costs paid for by insurance even if weight loss surgery isn’t covered. It’s all about how your doctor and hospital submit your claims to your insurance company.
For example, there are many non-bariatric surgery reasons for your doctor to recommend:
- Cardiology exam
- Lab work
- Medically supervised diet program
- Psychological exam
- Sleep study
These are ordered for many reasons other than bariatric surgery and may be covered as a result. If your doctor submits one of these claims using a weight loss surgery CPT code (Current Procedural Terminology Code), your insurance is unlikely to cover it. But if your doctor uses a general CPT code, it probably will be covered.
While this may sound “sneaky”, it is an ethical practice. After all, these tests will be beneficial regardless of whether you move forward with surgery.
Blue Cross Blue Shield of Montana Contact Information and Full Medical Policy on Bariatric Surgery
- Coverage Through Your Employer
- Individual & Family Plans
Before getting into the types of insurance plans, you can cut to the chase by contacting a local bariatric surgeon’s office. Most surgeons will contact your insurance company for free to confirm whether or not you’re covered.
Blue Cross Blue Shield of Montana does cover weight loss surgery, but your specific policy must include it in order for you get it covered.
Following are a list of Blue Cross Blue Shield of Montana plan types and whether they cover bariatric surgery:
Weight Loss Surgery for Health Plans Through Your Work
If you work for a company that has 50 or more full time employees, it is completely up to your employer to decide whether or not to cover bariatric surgery under your health plan.
To find out whether weight loss surgery is covered by your employer’s plan, you have a few options:
- Your local surgeon will usually be willing check your insurance for free. Click here to find a surgeon near you, then call or email them to request a free insurance review.
- Ask your Human Resources department
- Contact your insurance company directly using the phone number on your insurance ID card
Weight Loss Surgery for Individual/Family Plans
The Affordable Care Act (Obamacare) requires all individual and small group plans (less than 50 full time employees) to include weight loss surgery coverage as long as it is considered an “Essential Health Benefit” in your state.
The following states DO currently consider bariatric surgery an Essential Health Benefit (bariatric surgery is covered by all individual, family and small group plans in these states):
Your State Not on the List?
If your state is NOT on the list, then weight loss surgery is probably NOT covered under your plan.
First, contact your local surgeon to be sure. For no charge, their office will contact your insurance company on your behalf to work through the details.
If your surgeon confirms that your policy does not include obesity surgery, you still have several options for making surgery more affordable. See these pages for more information:
- Weight Loss Surgery Insurance Secrets: Revised List (good tips even if your policy does not include bariatric surgery)
- Financing bariatric surgery (all of your options)
- New Hampshire
- New Jersey
- New Mexico
- New York
- North Carolina
- North Dakota
- Rhode Island
- South Dakota
- West Virginia
Regardless of whether your state is on the list, contact a qualified surgeon to request a free insurance check to verify your coverage.
To review your insurance company’s obesity surgery coverage requirements, click here to jump back up the page.
Weight Loss Surgery for Medicare Plans
All Medicare plans are required to cover the following weight loss surgery procedures:
- Gastric sleeve surgery
- Gastric bypass surgery
- Gastric banding (lap band surgery) (LASGB)
- Duodenal switch surgery (DS)
- Biliopancreatic diversion surgery (BPD)
However, special Medicare-specific criteria apply. Click here to learn more about Medicare bariatric surgery coverage.
- Gastric Sleeve
- Gastric Bypass
- Duodenal Switch
Please see below for the procedures Blue Cross Blue Shield of Montana covers, might cover under certain circumstances, and those that are not covered under any circumstances:
Procedures That ARE Covered
- Gastric Sleeve Surgery
- Roux-en-Y Gastric Bypass
- Duodenal Switch (for patients with a BMI less than 50)
Procedures That MIGHT BE Covered
The following procedures MIGHT BE covered by Blue Cross Blue Shield of Montana:
Procedures That Are NOT Covered
The following procedures are NOT covered by Blue Cross Blue Shield of Montana:
- Gastric Balloon
- Vertical Banded Gastroplasty
- Mini Gastric Bypass Surgery
- Biliopancreatic bypass without duodenal switch
- Long-limb gastric bypass procedure (i.e., greater than 150 cm)
- Two-stage bariatric surgery procedures
- Laparoscopic gastric plication
- Endoscopic bariatric procedures, either as a primary procedure or as a revision procedure. This includes, but is not limited to:
- Insertion of the StomaphyX™ device
- Natural Orifice Transluminal Endoscopic Surgery
- Transoral ROSE procedure (Restorative Obesity Surgery)
- Sclerotherapy of the stoma
- Endoscopic gastroplasty
- Use of an endoscopically placed duodenojejunal sleeve
- General Appeal Instructions
- Appeal Details Specific to Blue Cross Blue Shield of Montana
If Blue Cross Blue Shield of Montana denies your weight loss surgery claim and you think it should be covered, consider filing an appeal.
- Ask for a free insurance check or cost quote
- Attend a free seminar or webinar
- Schedule a phone or in-person consultation (both often free)
Search the weight loss surgeon directory below to ask a surgeon about a free insurance check by country and region: