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Does wellcare of ky cover weight loss surgery 2025

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The document outlines the Clinical Coverage Guideline for Bariatric Surgery (Policy Number: HS-006) by WellCare, detailing the criteria for medical necessity, covered procedures, and requirements for patients seeking surgery for morbid obesity. It specifies eligibility based on Body Mass Index (BMI) and associated co-morbidities, mandates participation in a physician-supervised nutrition and exercise program, and emphasizes the need for mental health evaluations. The document also lists covered surgical procedures, non-covered procedures, and guidelines for facilities and providers involved in bariatric surgery.

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Click ‘Get Form’ to open it in the editor.
Begin by reviewing the policy number HS-006, which outlines the coverage for bariatric surgery. Familiarize yourself with the eligibility criteria, including BMI requirements and necessary documentation.
Fill in your personal information in the designated fields, ensuring accuracy as this will be crucial for processing your request.
Complete the sections regarding medical history and previous weight loss attempts. Be detailed about any physician-supervised programs you have participated in, as this is a key requirement.
If applicable, provide documentation of mental health evaluations and any co-morbidities that may support your case for surgery.
Review all entries for completeness and accuracy before submitting. Utilize our platform’s features to save your progress or share with a healthcare provider for review.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How to get insurance to approve weight loss surgery?

Common requirements are: Over age 18 (Some plans allow for surgery under age 18) BMI over 40 or BMI over 35 with high blood pressure, type 2 diabetes, or other risk factors. Documented weight loss efforts over a period of time. Weight loss program mandated by the insurance company. Psychological testing.

Does WellCare insurance pay for weight loss surgery?

Thank you for contacting us with your interest in weight loss surgery. Fortunately, your insurance DOES cover the procedure that we offer, however we have to prove that it is MEDICALLY NECESSARY. In addition, they require multiple clearances and additional documentation to prove this.

Does Kentucky Medicaid pay for weight loss surgery?

- Bariatric Surgery will be covered only if it is medically necessary and prior authorized. Note: Services for the treatment of obesity (including gastroplasty and gastric stapling) are generally not covered by KY Medicaid.

How much do you have to weigh for insurance to cover weight loss surgery?

Have a body mass index (BMI) of 35 or higher, or have a BMI between 30 and 35 and an obesity-related condition, such as heart disease, diabetes, high blood pressure or severe sleep apnea. Weigh less than 450 pounds, the maximum weight that hospital radiology equipment can accommodate.

What do I say to get approved for weight loss surgery?

Your team will need to show that the procedure is medically necessary. Also, you may need to provide documented evidence that you werent able to lose enough weight with a supervised program of diet and exercise. Medicare and some Medicaid programs may cover the costs.

does wellcare pay for dentures

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Why would my insurance deny weight loss surgery?

Payment may be denied because there may be a specific exclusion in your policy for obesity surgery or treatment of obesity. Such an exclusion can often be appealed when the surgical treatment is recommended by your surgeon or referring physician as the best therapy to relieve life-threatening obesity-related health

Does wellcare of ky cover weight loss surgery 2025

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How to get insurance to approve weight loss surgery?

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Why would my insurance deny weight loss surgery?

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