MMC Benefits Handbook
Obesity Surgery
NOTE: Out-of-network services are not covered under the Anthem BCBS Narrow Network (National Blue High Performance Network (Blue HPN)) except for urgent and emergency care. There are some providers in New Jersey and Philadelphia that are listed as Tier 2 on Anthem BCBS's provider search (National Blue High Performance Network (Blue HPN)) that can be used and are covered at the out-of-network benefit level. Providers not labeled as Tier 2 cannot be used for out of network coverage.
The plan covers surgical treatment of obesity provided by or under the direction of a physician. Coverage is limited to once per person per lifetime.
Prior authorization under the condition of meeting the medical definition of morbid obesity is required. All services, including surgery, must be obtained from a recognized in-network Blue Distinction provider. Contact the Claims Administrator for specific details on requirements and how to find a facility.
Travel and lodging expenses to and from your home will be reimbursed as defined below.
  • The patient is eligible for reimbursement if the facility is 100 miles or more from the patient's home.
  • The reimbursement for lodging expenses is limited to $50 per night.
  • The maximum reimbursement for all travel and lodging expenses is $10,000 per episode of care.