These procedures are considered medically necessary for treating morbid obesity. Gastric Bypass with Long-Limb Roux en Y anastomosis.Gastric Bypass with Short-Limb Roux en Y anastomosis.Laparoscopic Adjustable Gastric Banding.Biliopancreatic Diversion with Duodenal Switch.Horizon Blue Cross Blue Shield New Jersey covers the following weight loss surgeries: Types of Weight Loss Surgeries Covered By Horizon Blue Cross Blue Shield of New Jersey The patient has to fulfill all of the criteria listed above to be approved for bariatric surgery. You can see a full list of co-morbidities here. The bariatric surgeon should submit the proper paperwork for approval.The patient should have a letter of recommendation from his/her primary doctor.Undergone pre-operative psychological evaluation and understands the impacts of weight loss surgery.Your surgeon will typically have these available. Participated in a surgery preparation program to enhance results and lower risk of complications after the procedure.Completed a weight loss program for at least six consecutive months.The patient, in the 12 months before the surgery, has to have:.The patient is morbidly obese (i.e., has a Body Mass Index (BMI) of over 40 OR has a BMI of over 35) with a life-threatening co-morbid disease such as:.Weight loss surgery for patients under 17 years of age is not considered medically necessary unless full skeletal growth has been reached, and the patient suffers from a co-morbid condition, such as sleep apnea or hypertension.The patient is at least 18 years of age, and the patient’s skeletal growth is complete.Weight loss surgery for treating morbid obesity is considered medically necessary if the patient fulfills the following criteria: Horizon Blue Cross Blue Shield New Jersey Pre-Approval Requirements Please note that not all policies include coverage. To qualify for coverage of weight loss surgery your policy must include coverage. Horizon Blue Cross Blue Shield New Jersey covers weight loss surgery.
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