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BCBSNC will provide coverage for bariatric surgery when it is determined to be medically necessary because the medical criteria and guidelines shown below are met. Also see Policy Guidelines.
The IRS rules make it clear that all expenses that are directly related to the treatment of your problem of obesity can be itemized for tax deduction, subject to conditions. This includes all types of bariatric surgery procedures, such as gastric sleeve and gastric bypass.
From the insurance perspective, weight loss surgery has always been considered medically necessary. This means that weight loss surgery is not considered cosmetic, but rather is performed to decrease the health risks associated with severe obesity.
The answer is yes, as long as there is no specific exclusion clause to opt out of this coverage for lower premiums. However, even with valid BCBS bariatric surgery coverage, you will still have to meet certain eligibility requirements.
Under the Affordable Care Acts (ACA) Essential Health Benefits (EHB) Benchmark Plans, 23 states require that all individual, family, and small group insurance plans cover bariatric surgery. Those states are: Arizona. California.
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BCBS Illinois covers weight loss surgery. However, to qualify for coverage of weight loss surgery, your policy must include coverage. As not all policies include coverage, please talk directly to BCBS Illinois to find out if you policy includes coverage.
Medical guidelines The surgery may also be an option for an adult who meets these three conditions: BMI of 35 or higher. At least one obesity-related medical condition. At least six months of supervised weight-loss attempts.
Insurance providers may have different requirements for their coverage of weight loss surgery. Criteria can be mandated by your employer, a medical policy, or be plan-specific. Common requirements are: Over age 18 (Some plans allow for surgery under age 18)

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