BCBS of Nebraska Weight Loss Surgery – How to Avoid a Denial

Your Blue Cross Blue Shield of Nebraska 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.


Click on any of the topics below to jump directly to that section

  1. Coverage Requirements
  2. Coverage Plans
  3. Covered Procedures
  4. Appealing a Denial
  5. Find a Weight Loss Surgeon
Bariatric Surgery Source

Coverage Requirements


  • 35+ Body Mass Index (BMI)
  • Documentation of failed diet attempts
  • Psychological evaluation


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 Nebraska for bariatric surgery in the United States, you must meet the following criteria:

  1. Be age 18 or older
  2. Diagnosis of Morbid obesity, defined as
  3. Or

    • BMI 35 – 39.9 AND one of the following
      • Type 2 diabetes mellitus
      • Hypertension
      • Dyslipidemia
      • Coronary artery disease
      • Heart failure
      • Obstructive sleep apnea
      • Non-alcoholic fatty liver disease or non-alcoholic steatohepatitis
      • Pseudotumor cerebri
      • Osteoarthritis
      • Gastroesophageal reflux disease (GERD)

    Use this BMI Calculator to check your body mass index…

  4. Prior to bariatric surgery, patients should participate in a comprehensive treatment program for weight management. This supervised program should include both dietary modifications, as well as physical activity. Techniques that may be used to teach behavioral skills to patients include, self monitoring, goal setting, positive reinforcement, social support, and relapse prevention.
  5. A comprehensive preoperative evaluation is essential in the work-up of the obese patient. The goals of screening are to identify comorbid conditions. The multidisciplinary team should also evaluate noncompliance, psychiatric illness, substance abuse, medical and surgical history, and unreasonable postoperative expectations.
  6. A psychosocial evaluation should be performed to assess for current drug and alcohol misuse which is considered a contraindication to surgery. Patients who have a history of substance misuse should demonstrate one year or more of continuous sobriety before weight loss surgery is considered.
  7. A significant percentage of bariatric surgery patients have a history of diagnosed or undiagnosed psychopathology, including mood or anxiety disorders, post-traumatic stress disorder, and eating disorders. Although none of these conditions are exclusionary, all patients should be screened to assess stability and understanding of both the procedure and the postoperative follow-up. Patients with unstable disease should be referred to a behavioral health provider and surgery deferred until the patient is stabilized.
  8. Cigarette smoking cessation should occur at least 6 weeks prior to bariatric surgery, as smoking has been associated with an increased risk of impaired wound healing, anastomotic ulcer, and general poor health.
  9. Nutritional counseling is essential for the patient who is undergoing bariatric surgery. ALl procedures involve a lifelong commitment to changed eating patterns and sufficient protein consumption; some may require nutrient supplementation postoperatively. Failure to adhere to eating plans can result in nausea, vomiting, pain, nutritional deficiencies, metabolic bone disease, and failure to achieve desired weight loss.

Revision Requirements

These criteria cover revisional procedures for patients who fail to maintain or achieve the expected weight loss after their initial bariatric surgery and do not address patients in which reoperation is related to a complication from surgery or related to complications caused by patient’s failure to adhere to recommended postoperative care.

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 Nebraska Contact Information and Full Medical Policy on Bariatric Surgery


Coverage by Plan Type


  • Coverage Through Your Employer
  • Individual & Family Plans
  • Medicare

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.

Click here to find a local surgeon and ask them to check your insurance for you for free.

Blue Cross Blue Shield of Nebraska 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 Nebraska 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:

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:

    • Arizona
    • California
    • Delaware
    • Hawaii
    • Illinois
    • Iowa
    • Maine
    • Maryland
    • Massachusetts
    • Michigan
    • Nevada
    • New Hampshire
    • New Jersey
    • New Mexico
    • New York
    • North Carolina
    • North Dakota
    • Oklahoma
    • Rhode Island
    • South Dakota
    • Vermont
    • West Virginia
    • Wyoming

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:

However, special Medicare-specific criteria apply. Click here to learn more about Medicare bariatric surgery coverage.

Bariatric Surgery Source

Covered Weight Loss Procedures


  • Gastric Sleeve
  • Gastric Bypass
  • Lap-Band
  • Duodenal Switch

Please see below for the procedures Blue Cross Blue Shield of Nebraska covers, might cover under certain circumstances, and those that are not covered under any circumstances:

Procedures That ARE Covered

Procedures That MIGHT BE Covered

The following procedures MIGHT BE covered by Blue Cross Blue Shield of Nebraska:

Procedures That Are NOT Covered

The following procedures are NOT covered by Blue Cross Blue Shield of Nebraska:


Appealing a Denial


  • General Appeal Instructions
  • Appeal Details Specific to Blue Cross Blue Shield of Nebraska

If Blue Cross Blue Shield of Nebraska denies your weight loss surgery claim and you think it should be covered, consider filing an appeal.

Our Health Insurance Appeals page will get you started, then head over to the Disputes & Appeals page for Blue Cross Blue Shield of Nebraska to learn how to proceed.


Find A Top Weight Loss Surgeon


  • 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:

Bariatric Surgery Source
* Disclaimers: Content: The information contained in this website is provided for general information purposes and your specific results may vary depending on a variety of circumstances. It is not intended as nor should be relied upon as medical advice. Rather, it is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her existing physician(s). Before you use any of the information provided in the site, you should seek the advice of a qualified medical, dietary, fitness or other appropriate professional. Advertising: Bariatric Surgery Source, LLC has entered into referral and advertising arrangements with certain medical practices, original equipment manufacturers, and financial companies under which we receive compensation (in the form of flat fees per qualifying action) when you click on links to our partners and/or submit information. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. Read More

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