© 2016 by Synergy Bariatrics

Medically Supervised Nutritional Therapy and Behavior Modification Program Requirement

 

Many insurance requires patients to complete a medically supervised nutritional therapy and behavior modification program before we can obtain authorization for bariatric surgery. The purpose of this program is to ensure that patients can adhere to the nutritional guidelines and commit to the lifestyle adjustments that need to be in place for successful outcomes following bariatric surgery.

 

Below is a list of insurances that require a medically supervised program prior to surgery. Please keep in mind that insurances can change their policies regarding bariatric surgery at any time. While we have attempted to make this list as inclusive as possible, it does not necessarily include ALL of the insurances that have this requirement. It is the responsibility of our patients to check what criteria must be met in order to have bariatric surgery covered.

 

Aetna

  • 6 months of documented medically supervised non-surgical attempts at weight loss within 2 years prior to surgery -- OR -- 3 consecutive months within 6 months prior to surgery

  • Documentation must not show a net weight gain

Amerigroup (BCBS Alliance)

  • 6 consecutive months of documented medically supervised non-surgical attempts at weight loss, occurring within 2 years prior to surgery

 

Anthem

  • 6 consecutive months of documented medically supervised non-surgical attempts at weight loss, occurring within 2 years prior to surgery

 

BCBS AL

  • 6 consecutive months of documented medically supervised non-surgical attempts at weight loss, occurring within 1 year prior to surgery

 

BCBS CA

  • 3 consecutive months of documented medically supervised non-surgical attempts at weight loss, occurring within 1 year prior to surgery

 

BCBS MI

  • 6 consecutive months of documented medically supervised non-surgical attempts at weight loss, occurring within 4 years prior to surgery

  • If your BMI is 50 or higher, then the 6 month requirement is waived

 

BCBS MN

  • 6 consecutive months of documented medically supervised non-surgical attempts at weight loss, occurring within 1 year prior to surgery

 

BCBS TN

  • 6 consecutive months of documented medically supervised non-surgical attempts at weight loss, occurring within 2 years prior to surgery

 

BCBS VT

  • 3 months of documented medically supervised non-surgical attempts at weight loss, occurring within 1 year prior to surgery

 

Champ VA

  • 3 consecutive months of documented medically supervised non-surgical attempts at weight loss, occurring within 2 years prior to surgery

 

Cigna

  • 3 consecutive months of documented medically supervised non-surgical attempts at weight loss, occurring within 1 year prior to surgery

 

Empire

  • 6 consecutive months of documented medically supervised non-surgical attempts at weight loss, occurring within 2 years prior to surgery

 

Excellus

  • 6 months of documented medically supervised non-surgical attempts at weight loss, occurring within 5 years prior to surgery

  • Months do NOT have to be consecutive

Independent Health Commercial

  • 6 consecutive months of documented medically supervised non-surgical attempts at weight loss, occurring within 6 months prior to surgery

Independent Health Self-Funded

  • 6 consecutive months of documented medically supervised non-surgical attempts at weight loss, occurring within 6 months prior to surgery

 

Magnacare

  • 6 consecutive months of documented medically supervised non-surgical attempts at weight loss, occurring within 2 years prior to surgery

 

MVP

  • 6 consecutive months of documented medically supervised non-surgical attempts at weight loss, occurring within 2 years prior to surgery

 

NOVA

  • 6 consecutive months of documented medically supervised non-surgical attempts at weight loss, occurring within 6 months prior to surgery

 

POMCO

  • 3 consecutive months of documented medically supervised non-surgical attempts at weight loss, occurring within 2 years prior to surgery

 

Regence

  • 6 consecutive months of documented medically supervised non-surgical attempts at weight loss, occurring within 2 years prior to surgery

 

Tricare

  • 6 consecutive months of documented medically supervised non-surgical attempts at weight loss, occurring within 2 years prior to surgery

 

United HealthCare Commercial

  • 6 consecutive months – OR – two separate instances of 3 consecutive months of documented medically supervised non-surgical attempts at weight loss, occurring within 2 years prior to surgery

 

United HealthCare Community Plan

  • 6 months of documented medically supervised non-surgical attempts at weight loss, occurring within 2 years prior to surgery

  • Months do NOT have to be consecutive

 

Univera

  • 6 months of documented medically supervised non-surgical attempts at weight loss, occurring within 5 years prior to surgery

  • Months do NOT have to be consecutive

 

Univera Medicaid Plans

  • 6 months of documented medically supervised non-surgical attempts at weight loss, occurring within 5 years prior to surgery

  • Months do NOT have to be consecutive

 

Yourcare

  • 6 months of documented medically supervised non-surgical attempts at weight loss, occurring within 5 years prior to surgery

  • Months do NOT have to be consecutive