Plastic Surgeons in Beverly Hills - Los Angeles - Plastic Surgery

Weight Loss Surgery Insurance Companies

These are a list of some insurance companies and examples of some of the requirements that are mandatory prior to consider coverage for weight loss surgery.

These are a guidelines and examples from our experience, they are not the insurance company policies, and you must call your insurance company and ask for your policy requirements, referrals, pre-authorization, deductibles, in-network and out of network benefits.

If you do not find your insurance company on the following list, check with your member services department or your insurance company to find out what your insurance policy requirements are; and you must call your insurance company.

United Healthcare

1. History Physical including Height, weight with co-morbidities
2. Documented 5 years History of Morbid Obesity
3. Documented failure of 6 months of medically supervised non-surgical methods of weight reduction by MD, DO, Nurse Practitioner which includes:
• Nutrition therapy
• Behavior modifying exercise or increase activity
• Medication therapy and/or maintenance therapy
4. Psychological Evaluation
5. Documentation of willingness to comply with pre operative and post operative treatment plans.
6. Letter of Medical Necessity to include documentation of morbid obesity for at least 5 years or more, BMI over 40, presence of co-morbidities, 5 years or more of continuous documented morbid obesity
7. Documented continuous six (6) months of medically supervised weight loss program in the last two years
8. Cardiac and pulmonary function tests
9. Nutritionist evaluation
10. TSH, current
11. Drug/alcohol screening at their MD (depends on policy)
12. Understands surgical procedure

Blue Cross/Blue Shield

1. History Physical including Height, weight with co-morbidities
2. Documented 5 years History of Morbid Obesity
3. Documented failure of 1 year of medically supervised non-surgical methods of weight reduction by MD, DO, Nurse Practitioner which includes:
• Nutrition therapy
• Behavior modifying exercise or increase activity
• Medication therapy and/or maintenance therapy
4. Psychological Evaluation
5. Documentation of willingness to comply with pre operative and post operative treatment plans.
6. Letter of Medical Necessity to include documentation of morbid obesity for at least 5 years or more, BMI over 40, presence of co-morbidities, 5 years or more of continuous documented morbid obesity

Cigna

1. History Physical including Height, weight with co-morbidities
2. Documented 5 years History of Morbid Obesity
3. Documented failure of 6 months of medically supervised non-surgical methods of weight reduction by MD, DO, Nurse Practitioner which includes:
• Nutrition therapy
• Behavior modifying exercise or increase activity
• Medication therapy and/or maintenance therapy
4. Psychological Evaluation
5. Documentation of willingness to comply with pre operative and post operative treatment plans.
6. Letter of Medical Necessity to include documentation of morbid obesity for at least 5 years or more, BMI over 40, presence of co-morbidities, 5 years or more of continuous documented morbid obesity
7. At least two (2) documented medically supervised diets in the last two years lasting at least 6 months each (supervised by a physician and a registered dietitian)
8. Nutritionist evaluation
9. Medical clearance from a primary care physician
10. Detailed weight loss history with dates and outcomes for at least 5 years

Aetna

1. Presence of severe obesity that has persisted for at least 5 years, defined as any of the following:
1. Body mass index (BMI) exceeding 40 or
2. BMI greater than 35 with one of the following co-morbidities:
1. Coronary heart disease
2. Type 2 diabetes mellitus
3. Clinically significant obstructive sleep apnea
4. Medically refractory hypertension (blood pressure greater than 140 mmHg systolic and/or 90 mmHg diastolic despite optimal medical management.
2. Patient is 18 years of age or older
3. History Physical including Height, weight with co-morbidities
4. Documented 5 years History of Morbid Obesity
5. Documented failure of 6 months of medically supervised non-surgical methods of Weight reduction by MD, DO, Nurse Practitioner which includes • Nutrition therapy, • Behavior modifying exercise or increase activity, • Medication therapy and/or maintenance therapy.
6. Psychological Evaluation
7. Documentation of willingness to comply with pre operative and post operative treatment plans.
8. Letter of Medical Necessity to include documentation of morbid obesity for at least 5 years or more, BMI over 40, presence of co-morbidities, 5 years or more of continuous documented morbid obesity
9. Patient must have done one of the following two programs:
1. Physician supervised nutrition and exercise program that includes a dietitian consultation, low calorie diet, increased physical activity and behavioral modification for the duration of at least 6 months within 2 years prior of surgery. Must be documented in the medical record by an attending physician who supervised the patient’s participation. Documentation should include medical records of MD’s monthly assessment of the patient’s progress throughout the course of the nutrition and exercise program.
2. Multidisciplinary surgical preparatory program. Must last at least 3 months and include the following:
1. Consultation with a registered dietitian
2. Reduced-calorie diet supervised by the dietitian
3. Exercise regimen (unless contraindicated) to improve pulmonary reserve prior to surgery, supervised by exercise therapist or other qualified professional
4. Behavior modification supervised by a qualified professional
5. Documentation in the medical record of the patient’s participation. Documentation should include medical records of the MD’s initial assessment of the patient and the MD’s assessment of the patient’s progress at the completion of the program.

Humana

1. History Physical including Height, weight with co-morbidities.
2. Documented 5 years History of Morbid Obesity
3. Documented failure of 6 months of medically supervised non-surgical methods of weight reduction by MD, DO, Nurse Practitioner which includes:
• Nutrition therapy
• Behavior modifying exercise or increase activity
• Medication therapy and/or maintenance therapy
4. Psychological Evaluation
5. Documentation of willingness to comply with pre operative and post operative treatment plans.
6. Letter of Medical Necessity to include documentation of morbid obesity for at least 5 years or more, BMI over 40, presence of co-morbidities, 5 years or more of continuous documented morbid obesity