Copied & Pasted from the BCBS of Texas - Health Select/ERS Website:
http://www.bcbstx.com/hs/bariatric_surgery.html
Bariatric surgery is also commonly known as weight-loss surgery. To qualify for bariatric surgery coverage, you must meet all the requirements listed below.
Checklist of Requirements:
You must be an active employee or a return-to-work retiree* with five continuous years of Texas Employees Group Benefits Program (GBP) employment with no breaks in G.B.P. coverage. No breaks in coverage can include years of coverage with an H.M.O. in the G.B.P. ****The benefit is not available to dependents, retirees not enrolled in active employee benefits, or H.M.O. members, even if they have other insurance that covers bariatric surgery, such as Medicare.
You must undergo one of the covered bariatric surgical procedures at a Blue Distinction Center for Bariatric Surgery®.
You must have at least one other condition considered a co-morbidity, uncontrolled at maximum medical management, and which is generally expected to be reversed or improved by bariatric treatment to include, but not limited to: Diabetes;
Hypertension;
sleep apnea;
Dyslipidemia;
Coronary heart disease;
Osteoarthritis; or
Any other co-morbidity related to obesity that has not responded to maximum medical management and that is generally expected to be reversed or improved by bariatric treatment.
You must have been evaluated by a licensed professional counselor, psychologist, or psychiatrist within the 12 months before the request for predetermination of benefits.
You must have medical records documenting a five-year history of Body Mass Index (BMI) greater than or equal to 40.
You must have documented active participation in a comprehensive, non-surgical weight reduction program (for example, the BCBSTX weight management program) for at least 12 consecutive months during the 24 months before the date you apply for surgery.
After surgery, you must provide documentation that you have participated in a medically supervised lifestyle management program for maintaining weight loss and health goals (such as the BCBSTX weight management program) for 12 consecutive months after the date of surgery.
If you have questions about bariatric surgery coverage or benefits, contact Blue Cross and Blue Shield of Texas (BCBSTX) at (800) 252-8039.