endobj Directory ofBlue Distinction Centers and Blue Distinction Centers+ for Bariatric Surgery, Program Selection Criteria For Bariatric Surgery. Page 18. If you have surgery, some private Medicare Supplement plans might cover some out-of-pocket costs not covered under Original Medicare pays, such as . You can also locate a contact number and email address on their website after choosing your state. *GP( @ r UQ T9 endstream endobj 1203 0 obj <. We are on a mission to help educate millions the benefits of weight loss surgery. Returning Shopper? ALL *GP( @ r UQ T9 A weight which is at least 100 lbs. Bariatric Journal does not provide medical advice, diagnosis, nor treatment. *GP( @ r UQ T9 Learn about BCBS of Alabama's requirements for weight-loss surgery. This is the medical billing code for gastric bypass surgery. All rights reserved. *GP( @ r UQ T9 Greater than or equal to 18 years; or b. The following bariatric procedures are considered experimental/investigational, and therefore, non-covered because the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature. This Program aligns with the Metabolic and Bariatric Surgery Accreditation and Quality Improvement *GP( @ r UQ T9 Provider Discharge Form. 18 - FEP Blue Focus This policy provides direction on Blue Cross Blue Shield of North Dakota (BCBSND) reimbursement for global surgical package and subsequent services provided within the global surgery days. The member must meet all requirements. The individual's medical record documentation should indicate that all psychosocial issues have been identified and addressed; Psychological evaluation documentation must be within the last year; Individual selection is a critical process requiring psychiatric evaluation and a multidisciplinary team approach. Renew Illinois Individual, Family & Medicaid Health Insurance, Blue Cross Community MMAI (Medicare-Medicaid Plan), Illinois Health Plan Tiered Prescription Drug Lists, Making Your Health Insurance Work For You, Prescription Drug Changes and Pharmacy Information, Machine Readable Files for Transparency in Coverage. If the individual does not meetALLof the selection criteria for bariatric surgery, the procedure will be denied as not medically necessary. endobj CG-SURG-83 Bariatric Surgery and Other Treatments for - Anthem <> *GP( @ r UQ T9 Blue Cross Blue Shield of Alabama has helped individuals struggling with obesity who have tried various weight loss methods but havent been successful on their own. PDF CLINICAL MEDICAL POLICY - Highmark Health Options Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. This will depend on the type of policy you have purchased. x]6}W6&DtX-kC[ZVK~L`EzT*Y`&n|pzs{(Ri])7)77//|}Qo^Om^pomnpSoNoU]\G.ih5 Blue Cross Blue Shield Association is an association of independent Blue Cross and Blue Shield companies. *GP( @ r UQ T9 Generally, any procedure that is considered experimental will not be covered. hb```JB eaX `,mLBX*fLj yZq5Ugj 0;Rjy~(^QD=ysz(p'@%ssr?~oqj-w?d>Hzg.w ^p1*9V8(#]%IyE@Bq> :::h`` l "H2I&0&Y@$P9[X@D2J "*o2Sj0R 18 years of age (special consideration if under 18 with severe morbid obesity and special circumstances). Does Bcbs Cover Bariatric Surgery - SurgeryTalk.net *GP( @ r UQ T9 Blue Distinction Centers and Blue Distinction Centers+ for Bariatric Surgery offer a full range of bariatric surgery care, including: surgical. *GP( @ r UQ T9 The information you provide will enable us to assist you as efficiently as possible. Access Your Payment Options. of the following criteria is met: Individual postoperative noncompliance negates the efficacy of revision or conversion surgery. PDF 7.01.516 Bariatric Surgery - Premera Blue Cross 4 0 obj The Center of Excellence should be certified by the American College of Surgeons as a level 1 bariatric surgery center. Obesity is an increase in body weight beyond the limitation of skeletal and physical requirements, as a result of excessive accumulation of fat in the body. The criteria for selection to the Blue Distinction and Blue Distinction Centers+ for Bariatric Surgery program were developed with input from physician experts and medical organizations and include a comprehensive evaluation of structure, process and outcome measures. Learn more about weight loss surgery at Rocky Mountain Associated Physicians www.RMAP.com (801) 268-3800. Representatives are available 24 hours a day, seven days a week. Blue Distinction. This also applies to the Blue Care Network of Michigan. n+b%M@9A9 @@uP3\` 44L3vt M, D0u`BYEH28s1bi30cs7 *&1g Conservative measures for weight reduction should include changes to the individual's dietary, medication, and exercise regimen; The individual must complete a multidisciplinary evaluation including medical, nutritional, and psychological evaluations. Typically, if you paid cash for the procedure ongoing lap band fills will not be covered by insurance. 15 0 obj Requests for bariatric surgery for patients less than 18 years of age should include documentation that the primary care physician has addressed the risk of surgery on future growth, the patient's maturity level and the patient's ability to understand the procedure and Repeat surgical procedures for revision or conversion to another surgical procedure may be considered medically necessary when the initial bariatric surgery was medically necessary (and the individual continues to meet all the medical necessity criteria for bariatric surgery);andwhenANYONEof the following criteria is met: Internal Medical Policy Committee 11-29-2022 Coding update - December 06, 2022, Fargo (Headquarters) Morbid obesity is defined as a condition of consistent and uncontrollable weight gain that is characterized by. The Pouch Reset Losing Weight After Weight Regain, Expected Weight Loss From Gastric Sleeve Surgery Calculator, Recovery From Gastric Sleeve What To Expect From Day 1, Before And After Your Gastric Balloon [Complete Guide], 5 Ways to Prevent Stretching Your Stomach After Gastric Bypass. *GP( @ r UQ T9 Weight loss surgery is an effective treatment for morbid obesity. Gastric Sleeve Surgery. *GP( @ r UQ T9 These may include: The weight loss surgery should have been prescribed by a physician other than the operating surgeon. Individuals should have documented failure to respond to conservative measures for weight reduction prior to consideration of bariatric surgery, and these attempts should be reviewed by the practitioner prior to seeking approval for the surgical procedure. The panniculus hangs below the level of the pubis (which is documented in photographs); and One of the following: . The duration of the weight loss program should have been at least twelve consecutive months. tKU/!jLXeIrJ,J\KvI!xYFq3&ihZ7m) i?k\a! H#dP"WuUwo_KcW#p'Idj!C+Nw;PoW*Mr'X2NO @Xz8eQD z/zZK93t=VI ?H|&biA#3 azu5M,Ko0 JV;aO7>[Wo,el62XU]NovV:I= h *GP( @ r UQ T9 All rights . Any bariatric surgeon that accepts Blue Cross Blue Shield of Michigan will know where the surgery has to take place. a BMI of 35 or greater with at least 2 comorbidities. Body Mass Index (BMI) of 40 or greater OR. External link You are leaving this website/app (site). *GP( @ r UQ T9 Primary Care Physician's Letter. 5 0 obj Blue Cross Blue Shield of Michigan covers weight loss surgery. Weight loss is only one of the many health benefits of Bariatric surgery, but to consider the weight loss successful, patients must keep the weight off for a minimum of five years with the help of proper diet and regular exercise. endstream endobj 749 0 obj <. To contact Blue Cross Blue Shield of Alabama, you can either log into their official websitehttps://www.bcbsal.org/web/index.html, use the telephone numbers on the back of your BCBSA ID card or call 1-888-267-2955 for family and individual services. . In fact, most of the Blue Cross Blue Shield network has some sort of coverage for weight loss surgery. endobj stream Bariatric surgery is performed to treat morbid . Posted February 24, 2015. *GP( @ r UQ T9 *GP( @ r UQ T9 PDF BCBSM Medicare Advantage PPO Weight Loss Surgery Enhanced Benefit TEC . According to Blue Cross/Blue Shield of California Medically Necessary. The site may also contain non-Medicare related information. The Center of Excellence should also hold a certification by the American Society for Bariatric Surgery as a bariatric surgery Center of Excellence. The individual's medical record documentation should indicate that all psychosocial issues have been identified and addressed; The individual must be able to show decisional capacity and maturity in the psychological evaluation and provide informed assent for surgical management; The individual must be capable and willing to adhere to nutritional guidelines postoperatively; The individual must have a supportive and committed family environment; Selection criteria is a critical process requiring psychiatric evaluation and a multidisciplinary team approach. BCBS New York Excellus Weight Loss Surgery Kaiser Permanente Covers Weight Loss Surgery. Endoscopic procedures including but not limited to; StomaphyX device or restorative obesity surgery (ROSE) procedure; Gastrointestinal Liners (e.g., the EndoBarrier); Biliopancreatic bypass (the Scopinaro procedure) or laparoscopic; Vagal nerve blocking (VBLOC) therapy (neuromodulation non-metabolic), also known as the Maestro implant or Maestro rechargeable system; Single anastomosis duodenal-ileal bypass with Sleeve Gastrectomy (SIPS or SADI), Changed Title from Obesity to Bariatric Surgery, Sleeve gastrectomy is an eligible procedure as a first stage of a two-stage procedure. This policy version was replaced October 31, 2022. . *GP( @ r UQ T9 *GP( @ r UQ T9 *GP( @ r UQ T9 Skip to content. Weight loss is only one of the many health benefits of Bariatric surgery, but to consider the weight loss successful, patients must keep the weight off for a minimum of five years with the help of proper diet and regular exercise. 5 0 obj *GP( @ r UQ T9 A conversion to a sleeve gastrectomy, RYGB or biliopancreatic bypass with duodenal switch (BPD/DS) for individuals who have not had adequate weight loss success (defined as less than 50% of excess body weight) two (2) years following the primary bariatric surgery procedure and the individual has been compliant with a prescribed nutrition and exercise program following the procedure. Location: MO. *GP( @ r UQ T9 ,_*:1Ch_WpK3R6UYo gD_){6^9V0ljRoZY=;~lov'xmv'}y3-{lZjUTi:hnS: ]}}_v$j&m.~.?NIcWX*}pO=-f)/QeQ7vuT'UJ_\}Sj}NU~WOT}J"^ View Medical Policies | Excellus BlueCross BlueShield October 2017. Note: Designation as Blue Distinction Centers means these facilities' overall experience and aggregate data met objective criteria established in collaboration with expert clinicians' and leading professional organizations' recommendations. To view this file, you may need to install a PDF reader program. Blue Distinction Criteria. *GP( @ r UQ T9 QiP^0#jfc~%M/8 2E .vP[mc~9} *GP( @ r UQ T9 *GP( @ r UQ T9 Before calling make sure you see our questions to ask before calling your insurance company. One option is Adobe Reader which has a built-in reader. 4 0 obj there are documented recurrent or chronic rashes, infections, cellulitis, or non-healing ulcers, that do . Blue Distinction Centers for Bariatric Surgery | Blue Shield of CA This new site may be offered by a vendor or an independent third party. *GP( @ r UQ T9 Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. Bariatric surgery may be indicated for patients 18 to 60 years of age. Do I Need To Attend? Anthems full policy on weight loss surgery insurance coverage is no longer available online. *GP( @ r UQ T9 "Dental necessity" or "dentally necessary" means or describes a dental service that a dental care provider, exercising prudent clinical judgment, would provide to a covered person for the purpose of evaluating, diagnosing or treating a dental illness . Or. an Independent Licensee of the Blue Cross and Blue Shield Association If a conflict arises between a linical Payment and oding Policy ( ^ P P _) and any plan document under which a member is entitled to Covered Services, the plan document will govern. Check here bluecross blueshield fed blue bariatric official portal step by step. *GP( @ r UQ T9 and patient education. Bariatric Journal Editor. *GP( @ r UQ T9 *GP( @ r UQ T9 Relevant medical documents need to be submitted as proof that previous weight loss programs tried by the patient did not help. GQ^3>EtB0Pq*%`4)}S[]6 Va.sMnLdEcobqV}un s^-(w=f(o`?~~qC 7KPDBBERo>(^Bg,{8uWU tASR/a^_NX,vfUrOG(!YW_^H TTY users can call 1-877-486-2048. Bariatric Surgery for Morbid Obesity. Coverage is typically only offered if you followed the post-operative guidelines, changed your lifestyle and sought help from your bariatric surgeon, dietitian and other resources. *GP( @ r UQ T9 Procedures . 18 years of age (special consideration if under . *GP( @ r UQ T9 The items below are the minimum necessary for approval of your weight loss surgery. Bariatric and Transplant care benefits are limited to services provided in a Blue Distinction Center (see pages 62 and 66 ). We're committed to supporting you in providing quality care and services to the members in our network. Morbid *GP( @ r UQ T9 Anthem BCBS considers Lap Band fills a medical necessity when required to meet the proper level of weight loss. 2. 10 0 obj Skilled Nursing Facility and Inpatient Rehabilitation Fax Form. This site complies with the HONcode standard for trustworthy health information: Verify here. Do I have to use an in-network weight loss surgeon? Log In to the Shopping Cart, Need to Make a Payment? Corporate Medical Policy Bariatric Surgery - Blue Cross NC Is a Second Weight Loss Surgery Covered if Gastric Banding Didnt Work? *GP( @ r UQ T9 2019 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus. PPO outpatient services do not require Pre-Service Review. <> Covered Diagnosis Codes for Procedure Codes: 43644, 43770, 43775, 43843, 43846, and S2083, Covered Diagnosis Codes for Procedure Code: 43845, Internal Medical Policy Committee 3-16-2020 Revision, Internal Medical Policy Committee 11-19-2020 Revision, Internal Medical Policy Committee 11-23-2021 Revision. 0 <> PDF Bariatric Surgery - Regence To find out which services are covered under your policy at any facility, please call the customer service phone number on the back of your Blue Cross and Blue Shield of Texas member ID card. 1202 0 obj <> endobj Understanding Weight-Loss Surgery: Is it for you? post-op. hb``` cc`aX` r0(i``ZG!'f{ Revisions are covered if there is documentation of a failure secondary to a surgical complication. Revised: July 2022. It is important to know that your employer can typically opt-out of weight loss surgery insurance coverage for their employees policies. Forms | Providers | BlueCare Tennessee - BCBST Gastric banding, Lap Banding and Realize Band Gastric banding involve fitting an adjustable silicone band around the upper part of the stomach where the band restricts the amount of food and caloric intake, consequently allowing patients to lose up to 45% of their weight. No specific information regarding the requirement of an in-network surgeon is available. PDF 379 Medical and Surgical Management of Obesity and Anorexiants 4510 13th Ave. S. Gastric Sleeve Completed Tour; Gastric Sleeve Expecting Weights Loss, End; Average Cost of Gastric Sleeve Surgery; Abdominal Sleeve: After Surgery Results and Selling; Gastric Hose Surgery: Recovery Time; Gastric Sleeve Pre-Op Diet; Duodenal Sleeve Post-Op Diet Guide; Gastric Sleeve . @h23Begj!b4ZJ2}Y*bPc6d 5d 05dD/Br,Fsr#0Yi^kRsTCx aEt! *GP( @ r UQ T9 Blue Cross and Blue Shield of Minnesota reserves the right to revise, update and/or add to its medical policies at any time without notice. Weight Loss Surgery and the Insurance Process `FlM->e4m[OQ[M49%^B-:qfI_xEk/rMaEvA:Q9IZTq('IfPp(TM|:m)eoYZ2wtguH"tzxgf=JLu)RyN0 Blue Cross and Blue Shield is an association of . Bariatric Surgery Bariatric surgery is performed to treat morbid (clinically severe) obesity. This website uses cookies to improve your experience. Even when a policy covers weight loss surgery for qualifying patients, some situations may lead to a denial such as: You or your doctor can write a letter of appeal to the insurance company to appeal, you must, however, provide documentation for all the criteria listed in the policy as well as those from your previous communications with your insurance company about the surgery. Returning Shopper? Bariatric Surgery Which Procedure Is Best? (EGD) are considered an integral component of all bariatric procedures and are not eligible for separate payment when reported on the same day as the bariatric surgical procedure. The eligible bariatric surgical procedures listed above unless otherwise specified may be considered medically necessary for individuals under the age of 18 years when they meet 0BQp>>=5>g-9{{w[(e#(Px8. endobj Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association, PDF File is in portable document format (PDF). Fellow, American Society for Metabolic and Bariatric Surgery; SJ Magazine "Top Docs" - 2014, 2015, 2016, 2019, 2020, 2021, 2022; South Jersey Magazine "Best Doctors . In general, 20 percent to 30 percent above 'ideal' bodyweight, according to standard life insurance tables, constitutes obesity. accredited by the metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. endobj Yes, some Blue Cross Blue Shield plans may not cover bariatric surgery. To speak to someone directly, please call 1-773-702-1618. *GP( @ r UQ T9 Blue Cross covers services for the treatment of obesity, weight management, eating disorders, nutrition and physical activity counseling. Log In to the Shopping Cart, Need to Make a Payment? States Where Insurance Is Required To Cover Bariatric Surgery Under the Affordable Care Acts Essential Health Benefits Benchmark Plans, 23 states require that all individual, family, and small group insurance plans cover . *GP( @ r UQ T9 Rohit A Patel, MD, FACS, FASMBS | Cooper University Health Care Wellmark Blue Cross and Blue Shield is an independent licensee of the Blue Cross and Blue Shield . Do I Need To Attend? Anthem BCBS - Requirements for Weight Loss Surgery Sitemap, Bariatric Surgery 101 Guide: Read This First. accredited by the metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, . *GP( @ r UQ T9 PDF Medical Management of Obstructive Sleep Apnea Syndrome - Blue Cross and PDF 2022 Bariatric Surgery We removed the limit on covered non-sibling donors for transplant services . endobj Please refer to the criteria listed below for genetic testing. Register for MyBlue. FEP Blue Focus Prior Approval List - Effective January 1, 2023 . Goal Weight: 149 lbs. endobj To find out which services are covered under your policy at any facility, please call the customer service number listed on your Blue Cross and Blue Shield of Illinois member ID card. External link You are leaving this website/app (site). You will also be asked to sign a commitment form that requires to be on a medically supervised pre-operative diet as well as attend a support group before your surgery. *GP( @ r UQ T9 Bariatric Surgery for Obesity - UChicago Medicine However, an exclusion of weight loss surgery from your BCBS plan should not discourage you from exploring various low cost self-pay options. Complications can include but are not limited to fistula, obstruction or disruption of a suture/staple line. Understanding Health Care Costs and Quality, Provider Finder -Network Selection Criteria, HMO Provider Network Important Information, Making Your Health Insurance Work For You, Prescription Drug Changes and Pharmacy Information, Machine Readable Files for Transparency in Coverage. Outpatient Facility Average: $16,150. Weight loss surgery is an effective treatment for morbid obesity. *GP( @ r UQ T9 The Lap-Band procedure also uses adjustable silicone band placed around the top part of the stomach to restrict the amount of food your stomach can hold. It is at this point that an insurance verification coverage process is conducted as well as pre-operative testing. <>/Metadata 2592 0 R/ViewerPreferences 2593 0 R>> Blue Distinction Centers and Blue Distinction Centers+ for Bariatric Surgery offer a full range of bariatric surgery care, including: These centers have lower complication rates and fewer readmissions. PDF FEP Blue Focus Prior Approval List - Premera Blue Cross And you will still need to find a surgeon that has privileges to perform the surgery at a accredited Center Of Excellence for Bariatric Surgery. Active Participation and Documentation of non-surgical methods of weight loss. *GP( @ r UQ T9 In general, 20% to 30% above "ideal" bodyweight, according to standard life insurance tables, constitutes obesity. Benefits Section 5(c). Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically.