Blue Cross Blue Shield of Florida, now known as Florida Blue, is our state’s largest health insurance provider, with over 50% of Floridians covered under their plans. BCBS offers members a range of plans, including Individual & Family, Medicare, and Group Health. MASJax providers are in-network for most of these plans. Our team is happy to discuss your benefits and coverage for weight loss surgery and help guide you through what is required for coverage.
Note: In-network providers can offer lower costs than those out-of-network.
When evaluating your Florida Blue plan for bariatric surgery, the most crucial consideration is understanding what is covered along with any exclusions in your policy. This can typically be done through a phone call to your insurance provider or by meeting with the benefits manager of your Human Resources Department if your coverage is through an employer. If bariatric surgery is not a covered benefit of your plan, you will typically find this in the exclusions section of the policy documentation. If weight loss surgery is a covered benefit, a section is generally dedicated to the exact coverages for bariatric surgery and obesity treatment. It is important to note that coverage can vary between plans and groups. We encourage you to contact BCBS Florida and our office to find out more and verify your eligibility.
Exact coverage for surgery will vary based on your benefits. We encourage patients to call BCBS Florida Blue directly using the phone number on your insurance card or speak to your HR department for policies through your employer. During your office consultation, our Bariatric Coordinator will spend time with you to review your specific benefits and obligations, including what may be required for coverage.
Many plans have deductibles, co-insurance, and out-of-pocket maximums that reset with the calendar year each January 1st. If you are approaching the end of the year, your out-of-pocket surgery expenses may be lower if you have already paid for medical treatment earlier in the year. Please keep in mind that several required visits may be required before surgery. It is best to plan several months in advance, even if you take advantage of a paid deductible or met the out-of-pocket max for bariatric surgery.
Requirements for surgery coverage will vary between each plan and the group’s benefits. These general guidelines for pre-approval of bariatric surgery are standard, but specific requirements may be unique to your policy:
Florida Blue covers several bariatric procedures, including the gastric sleeve or sleeve gastrectomy and the gastric bypass. These are the two most popular weight loss surgeries and are proven effective procedures. Some patients will be candidates for Lap-Band or duodenal switch surgery, which may also be covered by insurance. Your surgeon will discuss your procedure options and the pros and cons of each with your unique needs and goals at your consultation.
BCBS of Florida does not cover some bariatric procedures. These include the intragastric balloon, Lap-Band for lower BMI patients, and any surgeries they consider experimental, such as Mini Gastric Bypass.
If a primary procedure you underwent in the past was not successful, Florida Blue might cover a revision bariatric surgery. Typically, documentation in the medical record is required to show the cause of failure is not a lifestyle consideration. Coverage for revision of bariatric surgery may require additional documentation. Please get in touch with our office if you are interested in pursuing a secondary weight loss surgery.
Despite the success rate and track record of bariatric surgery improving health, not all plans or groups include coverage for weight loss surgery. This does not mean you do not have options! MASJax offers competitive self-pay options that may suit your needs, including working with third-party financing. If you do not have coverage for surgery, or you have a high deductible or out-of-pocket to be met, we invite you to speak with our team to learn more about how we can assist you. You may also wish to compare plans available through a spouse’s coverage or contact the HR department at your workplace to see if they have incentives for weight loss and bariatric surgery or if changes might be made in the next open enrollment period.
Blue Cross Blue Shield of Florida can be contacted via email or telephone. Please be mindful that the contact number may be different depending on the type of plan you have. The best number to reach a representative for assistance is typically listed on the reverse side of your insurance card. For other contact options: https://www.floridablue.com/general/contact-us