Does Anthem Insurance cover weight loss surgery?

Does Anthem Insurance cover weight loss surgery?
Image: Does Anthem Insurance cover weight loss surgery?

Yes, Anthem insurance covers weight loss surgery in some cases. Generally, the plan must provide coverage for bariatric surgery as an included benefit, or members may be able to access coverage if they meet certain criteria. The specifics of coverage will vary based on the individual plan and can include requirements related to body mass index (BMI), a minimum amount of documented unsuccessful attempts at medical weight management, lab results and other medical documentation.

Overview of Anthem Insurance

Overview of Anthem Insurance
Image: Overview of Anthem Insurance

Anthem Insurance is a trusted provider for medical coverage. They offer affordable plans with many different options, such as dental care, vision services and hearing aids. Anthem also provides specialties in weight loss surgery, helping individuals achieve their body goals through medically-approved procedures. The company offers an extensive array of solutions that can be tailored to fit each individual’s needs – whether they are looking for short-term fixes or long-term treatments.

When it comes to insurance coverage related to weight loss surgery, Anthem has a lot to offer. Depending on the plan chosen, customers may be eligible for discounts and incentives on bariatric treatments like lap band and gastric bypasses. Some plans even cover expenses such as doctor visits and hospital stays up to certain limits. In addition to this, some policies will even provide nutritional counseling sessions with registered dietitians or nutritionists who are experts in pre- and postoperative dietary habits.

The level of coverage that Anthem Insurance provides is incredibly beneficial for those considering undergoing weight loss surgery – both financially and mentally. Their top-tier customer service department makes sure all questions are answered properly so that customers can make educated decisions about their healthcare needs without any surprises down the line. From filing claims forms to understanding benefits; the experienced team at Anthem has got you covered every step of the way.

What Weight Loss Surgery is Covered by Anthem?

What Weight Loss Surgery is Covered by Anthem?
Image: What Weight Loss Surgery is Covered by Anthem?

For people interested in bariatric surgery and considering if their health plan covers the procedure, it is important to understand what types of weight loss surgery are covered by Anthem Insurance. Generally speaking, Anthem provides coverage for different kinds of bariatric procedures when deemed medically necessary.

One particular type of weight loss procedure that can be approved for coverage by Anthem is Laparoscopic Adjustable Gastric Banding (LAGB), more commonly known as Lap-Band Surgery. This type of bariatric operation involves a silicon band being placed around the top part of the stomach to reduce its capacity and thereby limit how much food a person can eat at one time. It requires several follow-up visits with a surgeon to adjust or tighten the band as well as ongoing monitoring over a period of years following the initial procedure.

Another form of bariatric surgery that Anthem may cover is Roux-en Y gastric bypass which permanently alters how food enters and leaves your stomach, allowing you to feel full on smaller amounts than before while also reducing calories absorption from some nutrients. The RYGB typically results in substantial long-term weight loss but could require additional medical procedures afterwards due to possible nutritional deficiencies caused by malabsorption induced by this operation.

Factors that Determine Eligibility for Coverage

Factors that Determine Eligibility for Coverage
Image: Factors that Determine Eligibility for Coverage

When exploring the potential of Anthem insurance coverage for weight loss surgery, it’s important to consider some of the factors that determine whether or not a patient is eligible. Generally, an individual must be medically obese and unable to improve their condition through more traditional means like lifestyle changes and dieting in order for this type of treatment to be approved by Anthem. This means that individuals who are otherwise healthy may not qualify for such coverage even though they may want to explore this option due to aesthetic reasons.

Another factor for consideration when investigating whether or not one is eligible for weight loss surgery through Anthem is how much excess fat tissue a person carries. It’s not uncommon for policies of different health insurers such as Anthem will have specific criteria based on one’s Body Mass Index (BMI). Individuals whose BMI falls into the “obese” category (defined as carrying 30 percent more body fat than what is considered average) typically qualify while those with BMIs below that threshold don’t usually meet criteria. In other words, if you’re carrying around extra pounds but are still within a normal range according to your height-weight ratio, you’re unlikely to be able to receive assistance from insurance companies including Anthem.

There are also age restrictions which often come into play when applying for coverage for weight loss surgery through Anthem insurance plans–primarily because younger patients may still experience periods of rapid physical development which could reverse the results obtained from such surgeries over time. To ensure long-term success and benefit from such procedures, applicants must usually be 18 years old or older at the time of application; certain exceptions do apply under special circumstances depending on each individual case however, so it’s always important to check with medical professionals prior making any decisions regarding treatments and eligibility requirements pertaining thereto.

Financial Requirements for Surgery Coverage

Financial Requirements for Surgery Coverage
Image: Financial Requirements for Surgery Coverage

For those seeking surgery to aid in weight loss, Anthem insurance has financial requirements that must be met before they will cover the costs. Depending on the plan, some may require a co-pay while others do not and most plans have specific deductible amounts. In order to determine if your policy covers surgery you should review the terms of your coverage or contact customer service for further information.

Along with meeting any deductibles, some policies may also require a prior authorization process in order to get approval for coverage. This is typically done through documentation submitted by both the doctor and patient. The documents typically include information about why this type of procedure is needed as well as proof of diagnosis from other medical treatments or examinations related to obesity.

In cases where there are multiple obesity treatment options available, Anthem Insurance generally requires pre-authorization on all weight loss procedures as part of their commitment to promote evidence based medicine. Patients are able to submit appeals and exceptions if additional criteria can be provided regarding more complex cases. Services such as nutritional counseling and bariatrician visits may also be covered depending on individual policies so it’s important to find out what your plan covers before undergoing any surgery related procedures.

Types of Surgeries That Are Not Covered by Anthem Insurance

Types of Surgeries That Are Not Covered by Anthem Insurance
Image: Types of Surgeries That Are Not Covered by Anthem Insurance

When it comes to weight loss surgery, many people consider having the procedure covered by health insurance. However, not all insurers cover certain types of operations and Anthem Insurance is no different. They have a set list of surgeries they will not provide coverage for – even when medically necessary – which could leave a patient paying for their medical costs out-of-pocket.

One popular surgery that Anthem Insurance does not cover is body contouring after extreme weight loss. Body contouring following significant weight reduction can involve arm lifts, thigh lifts, breast lift and tummy tucks among other procedures. These types of operations are deemed cosmetic in nature and therefore ineligible for reimbursement from most major insurers, including Anthem insurance. While these surgeries may help improve self-image post weight loss or bariatric surgery, the cost often falls solely on the individual having the operation done due to lack of coverage from health insurance companies like Anthem Insurance.

In addition to cosmetic procedures performed following bariatric surgery, Anthem Insurance also refuses coverage for any type of gastric balloon procedure used as an alternative to more invasive weight loss methods such as gastric bypass or lap banding. Gastric balloons are inserted into a patient’s stomach temporarily via endoscopy with saline solution causing them to feel full quicker when eating leading them to consume less food over time in order to reduce calorie intake overall and result in sustained fat loss if combined with exercise programing – however this method is considered investigational at best according to most medical providers and thus not eligible for coverage under Anthem Insurance plans.

Other Considerations to Keep in Mind

Other Considerations to Keep in Mind
Image: Other Considerations to Keep in Mind

For those looking to undergo weight loss surgery and are using Anthem insurance, there is a few considerations to bear in mind. First of all, it is important to understand that surgeries like gastric bypass or sleeve gastrectomy are not always covered by the insurer. However, some Anthem plans may be able to cover part or all of the cost.

When determining if a procedure will be approved, Anthem will require an assessment by a medical expert who can verify that the surgical intervention is necessary for health-related purposes. Patients should also speak with their doctors about what additional steps need to be taken such as any lifestyle changes needed for eligibility for coverage.

Certain kinds of bariatric procedures might only be available through specific providers within the network and it could take longer for procedures outside of the network to receive authorization from Anthem Insurance. Thus, it’s critical for patients to make sure they are familiar with their plan and its associated benefits before pursuing any kind of weight-loss surgery.

  • James Berkeley

    ตั้งอยู่ในกรุงเทพฯ, James ทำให้การประกันภัยเรียบง่ายด้วยการสัมผัสที่เป็นส่วนตัว ภูมิใจที่เป็นศิษย์เก่าของ University of Edinburgh Business School พร้อมด้วย MSc in Law.


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