Does Blue Cross and Shield of Alabama cover lap band surgery?
Blue Cross and Shield of Alabama (BCBSAL) may cover lap band surgery, also known as adjustable gastric banding, under certain conditions. Coverage can vary depending on your specific health plan and individual circumstances. Here's what you need to know about BCBSAL's coverage for lap band surgery:
1. Medical Necessity: Lap band surgery is generally covered when it is considered medically necessary for the treatment of severe obesity. This means that other weight loss methods, such as diet and exercise, have failed or have not been successful in achieving significant weight loss.
2. Body Mass Index (BMI) Requirements: BCBSAL typically requires a BMI of 40 or higher for coverage of lap band surgery. In some cases, coverage may be available for individuals with a BMI of 35 or higher if they have certain obesity-related health conditions, such as sleep apnea, type 2 diabetes, or heart disease.
3. Preauthorization: Lap band surgery usually requires preauthorization from BCBSAL before the procedure can be performed. This means that you or your doctor must submit a request to BCBSAL for approval, providing medical records and other supporting documentation to demonstrate the medical necessity of the surgery.
4. In-Network Providers: BCBSAL generally recommends that you seek treatment for lap band surgery from in-network providers, as they have negotiated rates with the insurance company. Choosing an in-network provider can often result in lower out-of-pocket costs for the procedure.
5. Coinsurance and Deductible: Lap band surgery may be subject to your health plan's coinsurance and deductible. Coinsurance is a percentage of the total cost that you are responsible for paying, while the deductible is the amount you must pay out-of-pocket before your insurance coverage kicks in.
6. Exclusions and Limitations: Certain exclusions and limitations may apply to BCBSAL's coverage for lap band surgery. For instance, coverage may be limited to a certain number of years or may not include revision surgeries or complications that arise after the procedure.
It's important to note that coverage information can change, so it is always best to contact BCBSAL directly or refer to your specific health plan documents to confirm the current coverage details and any specific requirements or exclusions that may apply to lap band surgery.