Does Hmsa Cover Bariatric Surgery?

Let’s answer the question, Does Hmsa Cover Bariatric Surgery? The coverage of HMSA  insurance can vary according to various factors.

These factors are as follows:

We can summarize as follows.

35+ Body Mass Index (BMI),

Transcripts of your failed diet attempts,

Psychological evaluation from a specialist.

Even if some plans of your insurance company cover bariatric surgery, this does not mean that your particular plan covers bariatric surgery.

We list the bariatric surgery approval conditions that we will list in this article, assuming that weight loss surgery is covered by your private policy.

You can contact a surgeon to find out if your private policy covers bariatric surgery. Or you can contact your insurance company directly.

In the United States, you must meet the following criteria:

You must be over 18 years old.

A specialist should diagnose you with morbid obesity.
So your Body Mass Index (BMI) must be over 40

Or you must have a BMI of 35 to 39.9 and also have one of the following:

Severe sleep apnea

Pickwick syndrome

cardiomyopathy

Type II diabetes

Endocrinologists, psychiatrists, surgeons, dietitians, nurse practitioners should evaluate you in a program that offers comprehensive weight management services. Alternatively, you can apply to a Medicare-defined Center of Excellence.

In addition, this program is a weight loss program, exercise guidance and support, nutritional counseling, education about lifestyle changes, preparation and follow-up for surgery, should include support groups for patients before and after surgery.

The conditions for adolescents are as follows.

Adolescents must meet the weight requirement of adults in order to have morbid obesity surgery. However, more attention is paid to psychosocial, informational and consent forms that will be prepared for adolescents.

If Your Policy Doesn’t Cover

If your policy does not cover bariatric surgery, you can request partial coverage. In this case, even if your insurance does not cover the entire weight loss surgery, it will be able to cover some of the costs you will make. The important thing here is the communication between your doctor and the hospital with your insurance company.

For example, cardiology test, without using the weight loss surgery CPT code,
laboratory work, diet program, psychological assessment, your insurance will cover them if they request services such as sleep testing.

However, your doctor will code your weight loss surgery CPT insurance will not cover these claims. However, if your doctor uses a generic CPT code, they will likely meet it.

This practice is ethical, even if it doesn’t look like it. Because even if you do not continue your treatment with surgery, you will need to receive these services.

HMSA Blue Cross Blue Shield covers weight loss surgery, but as we mentioned earlier your specific policy must include it before you can take advantage of it.

Let’s Take A Look At A List Of HMSA Blue Cross Blue Shield Plan Types And Whether They Cover Bariatric Surgery

Let’s examine it under three headings:

Coverage Through Your Employer,

Individual & Family Plans,

Medicare.

It became mandatory for all insurance companies in 23 states to cover weight loss surgery after the Affordable Care Act was enacted for Individual Plans, Family Plans, and Small Group Plans (employers with fewer than 50 full-time employees).

Here are your options for getting your insurance approved to cover Bariatric surgery:
• Your own surgeon can confirm your coverage free of charge by contacting your insurance company, even if you are not going to proceed with surgery. Surgeons are familiar with insurance company approval processes, so you can trust them with confidence.
• Absolutely you can contact your insurance company yourself. And should check your summary plan description.

Insurance coverage guidelines for bariatric surgery are the same as for individual or family insurance for Health Plans Through Your Work

There are three options for approving bariatric surgery insurance coverage for Health Plans Through Your Work:

(Recommended option): Firstly your doctor can contact to your insurance company for you. Moreover it doesn’t change anything if you give up on surgery during the process. Your own surgeon has a great deal of control over insurance companies’ approval processes.

Secondly you can apply to the Human Resources Department of the company you work for about this issue.
Always valid option: you can contact your insurance company yourself. And check your Summary Plan Statement.

Also Medicare  cover the following procedures if you meet all of the listed criteria:
Gastric sleeve surgery (laparoscopic only),
Gastric bypass surgery (open or laparoscopic),
Lap band surgery (laparoscopic only),
Biliopancreatic diversion (open or laparoscopic) with duodenal switch (BPD/DS)

What Should You Do If Your Insurance Policy Does Not Cover Bariatric Surgery?

If your insurance does not cover weight loss surgery despite what we have listed above, it is probably not in your policy.

First, you should check with your surgeon to be sure. It will contact your insurance company for you free of charge. Don’t worry, surgeons and their offices are in contact with insurance companies. Therefore, they know very well how the process works.

If your surgeon concludes that your policy does not cover bariatric surgery, you can ask for a tip to reduce the cost.

For detailed information on this, you can check our other articles. However, you can find a lot of useful information about it on the internet.

If these tips don’t work for you, our advice would be to make changes to your insurance company or policy.

As A Result

If you meet all the criteria mentioned above, don’t worry, your insurance will cover your obesity surgery. We have mentioned a little about what you can do if you don’t. However, if these are not enough, we recommend that you consult with your surgeon first. He has every detail that can help you with this.

Finally, you can get more detailed and precise information about this process by contacting your insurance. Because insurance companies can file each customer’s file separately examines and evaluates accordingly.

Remember, your doctor and insurance company will always be ready to apply the methods that are best for you. If you are not satisfied, you can always change it.

What is Bariatric Surgery? Learn the Difference Here

Wondering what is bariatric surgery? Bariatric surgery is a type of surgery for weight loss used to help individuals with severe obesity lose weight and reduce their risk of developing related health conditions. The goal of bariatric surgery is to help individuals achieve a healthy weight and reduce the risk of developing obesity-related diseases. Bariatric surgery works by reducing the size of the stomach and/or bypassing part of the small intestine, so that food is not fully digested and absorbed. This leads to decreased calorie intake, which can result in significant weight loss. Bariatric surgery is often recommended for individuals with a body mass index (BMI) greater than 40. It is also for those with a BMI greater than 35 who also have obesity-related health conditions, such as type 2 diabetes, heart disease, or sleep apnea.

Bariatric surgery is considered the safest weight loss surgery, but it is not without risks. Potential complications of bariatric surgery may include infection, hernia, blood clots, nutritional deficiencies, and other serious medical issues. So, it is important to discuss the potential risks and benefits with your doctor and understand “what is bariatric surgery?” for you before deciding if you could get it.