In order to qualify for weight loss surgery coverage under AHCCCS, a patient must meet the following criteria:
- Body Mass Index (BMI): The patient must have a BMI of 35 or higher, or a BMI of 30 or higher with at least one obesity-related medical condition such as diabetes, sleep apnea, or high blood pressure.
- Documentation of attempts at weight loss: The patient must have documentation of attempts at weight loss through lifestyle changes such as diet and exercise, as well as medically supervised weight loss programs.
- Medical necessity: The surgery must be deemed medically necessary by a healthcare professional in order to treat obesity-related health conditions.
- Psychological evaluation: The patient must undergo a psychological evaluation to ensure that they are mentally and emotionally prepared for the surgery and the lifestyle changes that will be required post-surgery.
If a patient meets these criteria, weight loss surgery may be covered under AHCCCS. However, it is important to note that not all bariatric surgery procedures may be covered, and some may require prior authorization. Additionally, patients may be responsible for co-payments or deductibles.
It is important to consult with a healthcare professional and AHCCCS representatives to fully understand the criteria and coverage options for weight loss surgery under AHCCCS. While weight loss surgery can be a valuable tool for those struggling with obesity, it should be approached as part of a comprehensive weight loss plan that includes lifestyle changes such as diet and exercise.
