Health Insurance Requirements

Aetna Insurance Requirement

  • Psychological evaluation 
  • Nutrition evaluation 
  • Letter from Primary physician 
    • Must include current and past medical history 
    • Must have document history showing of 5 years obesity 
    • Documentation of 6 month managed weight loss program must be provided (office notes with dates of weights and mention of counseling of losing weight) or 3 month multi disciplinary program. 
  • Letter from surgeon
*Subject to change. Please check with your insurance provider for the most up to date requirements.

Anthem Insurance Requirement

  • Psychological evaluation 
  • Nutrition evaluation 
  • Letter from Primary physician 
    • Must include current and past medical history. If they have ever put you on a 6 month managed weight loss program it must be included in the letter (office notes with dates of weigh in should be provided). 
  • Letter from surgeon 
  • Anthem/BCBS Federal requires 3 months of nutrition with all of the above. 
  • Anthem/BCBS out of state (example: Texas, New Jersey, California) require 6 months of nutrition. 
*Subject to change. Please check with your insurance provider for the most up to date requirements.

Cigna Insurance Requirement

  • Psychological evaluation 
  • Nutrition evaluation 6 months 
  • Letter from Primary physician 
    • Must include current and past medical history 
    • Must have document history showing of 5 years obesity 
Coverage Policy 
Bariatric surgery is specifically excluded under many benefit plans and may be governed by state and/or federal mandates. Please refer to the applicable benefit plan document to determine benefit availability and the terms and conditions of coverage. Unless excluded from the benefit plan, this service is covered when the following medical necessity criteria are met. CIGNA covers bariatric surgery using a covered procedure outlined below as medically necessary when ALL of the following criteria are met: 
The individual is ≥ 18 years of age or has reached full expected skeletal growth AND has evidence of EITHER of the following: 
  • a BMI (Body Mass Index) ≥ 40 
  • a BMI (Body Mass Index) 35-39.9 with at least one clinically significant comorbidity, including but not limited to, cardiovascular disease, Type 2 diabetes, hypertension, coronary artery disease, or pulmonary hypertension 
  • Failure of medical management including evidence of active participation within the last two years in a weight-management program that is supervised either by a physician or a registered dietician for a minimum of six months without significant gaps. The weight-management program must include monthly documentation of ALL of the following components: 
    • weight
    • current dietary program 
    • physical activity (e.g., exercise program) 
Programs such as Weight Watchers®, Jenny Craig®, and Optifast® are acceptable alternatives if done in conjunction with the supervision of a physician or registered dietician and detailed documentation of participation is available for review. For individuals with long-standing, morbid obesity, participation in a program within the last five years is sufficient if reasonable attendance in the weight-management program over an extended period of time of at least six months can be demonstrated. However, physician-supervised programs consisting exclusively of pharmacological management are not sufficient to meet this requirement. 

*Subject to change. Please check with your insurance provider for the most up to date requirements.

Connecticare Insurance Requirement

  • Psychological evaluation 
  • Nutrition evaluation 
  • Letter from Primary physician 
    • Must include current and past medical history
    • Must have document history showing of 5 years obesity 
    • Documentation of 6 month managed weight loss program must be provided (office notes with dates of weights and mention of counseling of losing weight). 
  • Letter from surgeon
*Subject to change. Please check with your insurance provider for the most up to date requirements.

Healthnet Insurance Requirement

  • Psychological evaluation 
  • Nutrition evaluation 
  • Letter from Primary physician 
    • Must include current and past medical history 
    • Must have document history showing of 5 years obesity 
    • Documentation showing managed weight (such as physician managed weight loss program, nutrition counseling) 
  • Letter from surgeon 
*Subject to change. Please check with your insurance provider for the most up to date requirements.

Medicare Insurance Requirements

  • Psychological evaluation 
  • Nutrition evaluation 
  • Letter from Primary physician 
    • Letter must include current and past medical history. If they have ever put you on a 6 month managed weight loss program it must be included in the letter (office notes with dates of weigh in should be provided as well). 
*Subject to change. Please check with your insurance provider for the most up to date requirements.

Oxford Insurance Requirements

  • Psychological evaluation 
  • Nutrition evaluation 
  • Letter from Primary physician 
    • Must include current and past medical history 
    • Documentation of obesity for the past 5 years 
  • Thyroid Results (thyroid blood work that includes thyroid levels) 
  • Letter from surgeon 
*Subject to change. Please check with your insurance provider for the most up to date requirements.

State Insurance Requirements

  • Psychological evaluation 
  • Nutrition evaluation (6 months of nutrition visits) 
  • Letter from Primary physician 
    • Must include current and past medical history 
    • Must have 6 months of managed weight loss program, it must be included in the letter (office notes with dates of the weigh in should be provided) 
  • Cardiac Clearance (letter from a cardiologist saying that you are cleared for surgery along with the tests that were performed) 
  • Pulmonary Clearance (letter saying that you are cleared for surgery along with the tests that were performed) 
  • H-pylori test (blood test if positive read, must have documentation of treatment) 
  • Thyroid test (blood work that shows thyroid levels) 
*Subject to change. Please check with your insurance provider for the most up to date requirements.

Tricare Insurance Requirements

  • You must be 100 pounds over your ideal body weight 
  • Psychological evaluation (drug/alcohol abuse past/present history) 
  • Nutrition evaluation 
  • Letter from Primary physician 
    • Must include current and past medical history. If they ever put you on a 6 month managed weight loss program it must be included in the letter (office notes with dates of weigh in should be provided). 
  • Results from Thyroid function test (TSH) 
  • Results from H-pylori test 
  • Cardiac Clearance (signed) EKG (signed) 
  • Pulmonary Clearance (if requested) 
  • Letter from surgeon 
*Subject to change. Please check with your insurance provider for the most up to date requirements.