Hi, I have BCBS MA (PPO). My surgeon submitted all of the paperwork for me - he certified it as medically necessary. The criteria for BCBS MA is very general, this is strait from their site:
Obesity Surgery: We cover the following gastrointestinal surgery for obesity in patients who meet the following requirements below:
Vertical-banded gastroplasty (gastric stapling)1,2,9
Gastric bypass using Roux-en-Y anastomosis short limb (150 cm or less)1,2,9, 12 (open gastric bypass procedure with increased short limb length covered, effective 1/1/05)
Gastric banding consisting of an external band placed around the stomach9,10, 11 Note: The Lap-band system is contraindicated in non-adult patients (patients under 18 years of age) and therefore excluded from coverage.13
Patients who are morbidly obese are eligible for obesity surgery if ALL of the following are met:
morbid obesity (BMI > 40, or > 35 with co-morbid conditions)1
attempts at weight loss have failed1,2
obesity has persisted for at least 5 years2
no untreated metabolic cause for obesity, such as adrenal or thyroid disorders2
patient is an adult1
I have been overweight all of my life, my BMI is 51.5 and I was approved in one week (they have even given me 6 days in the hospital if needed). There was no fighting or constant phone calls - they were wonderful.
Good luck,