[oH:kv=(@me_Wu C w/n7}3N$*hX|! 14 0 obj This new site may be offered by a vendor or an independent third party. *GP( @ r UQ T9 comply with pre- and post-surgical requirements Note: . Individual outcomes may vary. The site may also contain non-Medicare related information. Read information on bariatric procedures, guides, find a surgeon and more. Bariatric surgery, falls into two general categories: 1) gastric-restrictive procedures that create a small gastric "Our comprehensive program helps patients [] *GP( @ r UQ T9 *GP( @ r UQ T9 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. Directory ofBlue Distinction Centers and Blue Distinction Centers+ for Bariatric Surgery, Program Selection Criteria For Bariatric Surgery. 1/5/2022 X Blue Cross Blue Shield of North Carolina 2,239,860 NC 12/2021 link 1/5/2022 X Medica Health 831,299 MN, NE, WI, IA, ND, SD 11/22/2021 link . . 1202 0 obj <> endobj Returning Shopper? Medicaids Criteria for Weight Loss Surgery Coverage. endstream endobj 749 0 obj <. %PDF-1.6 % *GP( @ r UQ T9 Blue Distinction Centers for Bariatric Surgery, along with the Blue Distinction . <> bluecross blueshield fed blue bariatric Guide bluecross blueshield fed blue bariatric Requirements bluecross blueshield fed blue bariatric web address bluecross blueshield fed blue bariatric valid Username & Password. If the individual does not meet *GP( @ r UQ T9 As a result, some centers require active participation in a formal weight reduction program that includes frequent documentation of weight, dietary regimen, and exercise. This does permit subsequent assessment of both the efficacy of the sleeve (to see whether the second stage is really needed), assessment of the compliance of the individual (to see whether the more complicated procedure is justified) or to examine the metabolic and nutritional effects of the sleeve (to see whether potential further metabolic derangements of the duodenal switch would make it unadvisable). or 100 percent over ideal weight or a body mass index (BMI) of at least 40 or a BMI of 35 with comorbidities. Substantially impaired quality of life or activities of daily living; Moderate to severe OSA (apnea-hypopnea index greater than 15); Individuals must 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. <> Effective May 01, 2023. 4 0 obj Log In to the Shopping Cart, Need to Make a Payment? <> endobj This new site may be offered by a vendor or an independent third party. Sometimes you will need to Read more Bariatric Surgery Which Procedure Is Best? *GP( @ r UQ T9 The eligible bariatric surgical procedures listed above unless otherwise specified are covered for individuals under the age of 18 years when they meetALLof the following criteria: If the adolescent does not meetALLof the adolescent selection criteria for bariatric surgery, the procedure will be denied as not medically necessary. However, you may want to have your bariatric surgeons office contact BCBS of Michigan directly and ask about coverage for a procedure that isnt listed above. Request an Appointment. *GP( @ r UQ T9 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. Greater than or equal to 18 years; or b. However, there is a lack of evidence on the optimal timing, intensity and duration of nonsurgical attempts at weight loss, and whether a medical weight loss program immediately preceding surgery improves outcomes; The individual must complete a psychological evaluation performed by a licensed mental health care professional and be recommended for bariatric surgery. *GP( @ r UQ T9 Pd-&mm@!U+V]]h)z'/6;]oB=u[_J^H\nt`Q[Lo{Kxcp=s}Fe?L&`mq8,!PvokA_EP%>O[ s{jSAx 6&mWwOoZLzwd\^d^77ojxmoF=+g^iKE*f{v+o'([~lr|Xj}h.]VF74;UBQ>Bw%}|LMWo/+wzW#9+O[0*9)/}b5FA@V:Kb6!eM_O$WBwg]5@uE Representatives are available 24 hours a day, seven days a week. 11 0 obj This site complies with the HONcode standard for trustworthy health information: Verify here. of the selection criteria for bariatric surgery, the procedure will be denied as not medically necessary. It requires abdominal incisions of up to ten inches for patients with extremely high BMI, those with certain health conditions that make laparoscopic surgery risky, or those with significant scar tissue from other abdominal medicine that may prevent access to the surgical area. 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. Oklahoma Medicare, health insurance renewal for individuals & families, Making Your Health Insurance Work For You, Prescription Drug Changes and Pharmacy Information, Machine Readable Files for Transparency in Coverage. 5 0 obj Benefits Section 5(c). <> 2022 Blue Cross and Blue Shield of Louisiana Blue Cross and Blue Shield of Louisiana is an independent licensee of the Blue Cross and Blue Shield Association and incorporated as Louisiana Health Service & Indemnity Company. Access Your Payment Options. *GP( @ r UQ T9 The items below are the minimum necessary for approval of your weight loss surgery. Individual outcomes may vary. Open and laparoscopic vertical banded Gastroplasty, Patients compliance with post-operative diet and exercise regimen. Surgeon: James Stephen Scott. ALL 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. =-]U6>(-Is[i5}{u?B}X* <> Conversion or revision surgery is considered not medically necessary when due to inadequate weight loss related to non-compliance with post-operative nutrition and exercise recommendations. So, to find out if your policy includes coverage, please talk directly to Blue Cross Michigan. One option is Adobe Reader which has a built-in reader. <> *GP( @ r UQ T9 Medicaids Criteria for Weight Loss Surgery Coverage. *GP( @ r UQ T9 *GP( @ r UQ T9 *GP( @ r UQ T9 ,_*:1Ch_WpK3R6UYo gD_){6^9V0ljRoZY=;~lov'xmv'}y3-{lZjUTi:hnS: ]}}_v$j&m.~.?NIcWX*}pO=-f)/QeQ7vuT'UJ_\}Sj}NU~WOT}J"^ 13 0 obj FEP Blue Focus Prior Approval List - Effective January 1, 2023 . Bariatric Surgery for Morbid Obesity. October 2017. The following are three types of weight loss procedures that are covered by BCBS Alabama. To see if your Anthem Blue Cross or Blue Shield of California Insurance Plan covers the Gastric Sleeve Surgery, please call us at 1-855-690-0559 or fill out our FREE Gastric Sleeve Insurance Verification Form and we will happily verify your Anthem Blue Cross or Blue Shield coverage for you! Bariatric Journal Editor. As a result, some centers require active participation in a formal weight reduction program that includes frequent documentation of weight, dietary regimen, and exercise. Morbid A psychological evaluation must be performed by a licensed mental health care professional, and the individual must be recommended for bariatric surgery. 1J-z](5K+XkXU)zc+2gUnRsXuQ@t>icv- {7V}*ymha.JS10NL](wnj`"5c+8L5TwB0mgbP{C]Z#H4:s PCD4N0"Pz}KP7A@mDY*/yiI @Z22*;/-"i1-mhqe,@e*De)KW8vYiI @Z22*;/-"iq@M&, e * PY$(NY`!%'NZ2 AHTyiHV}%0D0r, e9(KDElW4m'NZ2 AHTyiHm>e ,@e(, 8e"Q4Z'NZ2 AHTyiHu}fOY? e,@e*bs HYA$RV A*6 bhu/D0Cxi9 H! *GP( @ r UQ T9 Any bariatric surgeon that accepts Blue Cross Blue Shield of Michigan will know where the surgery has to take place. *GP( @ r UQ T9 Member meets one of the following BMI requirements and has been at that BMI for a minimum of 2 years: o BMI over 40 o BMI . Medical policies serve as one set of guidelines for determining what medical services, procedures, devices and drugs may be eligible for coverage. In general, 20 percent to 30 percent above 'ideal' bodyweight, according to standard life insurance tables, constitutes obesity. 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. If a patient is less than 18 years of age, a letter . Accept Read More, Blue Cross Blue Shield of Michigan Requirements for Weight Loss Surgery Approval, Gastric Sleeve Surgery Will My Stomach Stretch, Vitamin Guidelines After Bariatric Surgery, Gastric Sleeve Surgery The Complete Guide, Recovery From Gastric Sleeve What To Expect, Recovery From Lap Band Surgery What To, Gastric Bypass Vs. Gastric Sleeve Surgery, Expected Weight Loss From Gastric Bypass Calculator, 5 Ways to Prevent Stretching Your Stomach After, How Much Will You Weigh After Surgery Calculator, Cost of Gastric Sleeve (Sleeve Gastrectomy) Surgery, Lap Band Compared to Gastric Bypass Surgery, Mini-Gastric Bypass The Good, Bad, And Ugly. The member must meet all requirements. 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) n+b%M@9A9 @@uP3\` 44L3vt M, D0u`BYEH28s1bi30cs7 *&1g Repeat procedures for repair, revision, or conversion to another surgical procedure following a gastric bypass or gastric restrictive procedure not meeting the criteria as indicated in this policy are considered not medically necessary. Any bariatric surgeon that accepts Blue Cross Blue Shield of Michigan will know where the surgery has to take place. BCBS of Texas Criteria for Weight Loss United Healthcares Criteria For Weight Loss Surgery Coverage, Medicares Criteria For Weight Loss Surgery Coverage. Outpatient Facility Average: $16,150. Surgery Date: 03/24/2015. *GP( @ r UQ T9 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. Blue Distinction Centers for Bariatric Surgery, along with the Blue Distinction Centers for Cardiac Care, Blue Distinction Centers for Knee and Hip Replacement, Blue Distinction Centers for Maternity Care, Blue Distinction Centers for Spine Surgery, Blue Distinction Centers for Substance Use Treatment and Recovery and Blue Distinction Centers for Transplants are a key part of our efforts to work with doctors and facilities to improve the overall quality, and resulting affordability of specialty care. No specific information regarding the requirement of an in-network surgeon is available. One option is Adobe Reader which has a built-in reader. 2019 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus. Blue Distinction. x hb``` cc`aX` r0(i``ZG!'f{ For more information, please contact SKYGEN USA 1-855-878-5368. 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. What is a Weight Loss Seminar? *GP( @ r UQ T9 In general, 20% to 30% above "ideal" bodyweight, according to standard life insurance tables, constitutes obesity. As a result, some centers require active participation in a formal weight reduction program that includes frequent documentation of weight, dietary regimen, and exercise. endobj Bariatric Surgery . 3 0 obj accredited by the metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, . If the individual does not meetALLof the selection criteria for bariatric surgery, the procedure will be denied as not medically necessary. The letter should also state that the physician has evaluated the patients mental condition and he/she is fully prepared for the surgery. Gastric Banding including the Lap Band and Realize Band, Duodenal Switch also known as Biliopancreatic Diversion, Any other experimental weight loss procedure, The patient continues to meet all the medical necessity criteria for bariatric surgery, and, There must be documentation that the patient was compliant with the original post-operative dietary and exercise program, and. Surgical repair to correct perioperative or late chronic complications of a bariatric procedure may be considered medically necessary when there is documentation of a surgical complication related to the perioperative or late chronic complications of a bariatric procedure. ALL We're committed to supporting you in providing quality care and services to the members in our network. Morbid obesity is further defined as a condition of consistent and uncontrollable weight gain that is characterized by a weight which is at least 100 lbs. VII. So we are happy to report that manyAnthem BCBS policies cover weight loss surgery. In addition, some sites may require you to agree to their terms of use and privacy policy. *GP( @ r UQ T9 Full coverage for a weight loss surgery procedure will be provided to a patient with a Body Mass Index (BMI) over 40. Policy: 7.01.47 Effective Date: Nov. 1, 2022 Last Revised: Jan. 1, 2023 Replaces: 7.01.47 RELATED MEDICAL POLICIES: 2.01.38 Transesophageal Endoscopic Therapies for Gastroesophageal Reflux Disease 7.01.522 Gastric Electrical Stimulation . <> Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. *GP( @ r UQ T9 Blue Cross and Blue Shield is an association of . *GP( @ r UQ T9 xV]:}G?c;HU]zU?G\} 29gfjL}a? TJicTrXbfWllWfrZIUOzp*k}`o. Do I Need To Attend? *GP( @ r UQ T9 *GP( @ r UQ T9 @h23Begj!b4ZJ2}Y*bPc6d 5d 05dD/Br,Fsr#0Yi^kRsTCx aEt! . BCBS of Michigan provides full coverage for bariatric procedures provided the patient meets the following requirements: The patient's age is between 18 and 60. % *GP( @ r UQ T9 1238 0 obj <>stream To view this file, you may need to install a PDF reader program. 18 years of age (special consideration if under . Bariatric and Transplant care benefits are limited to services provided in a Blue Distinction Center (see pages 62 and 66 ). However, coverage and payment for these services depends on the type of provider submitting the claim, the procedure/service and diagnosis codes submitted, and the patient's contract with Blue Cross. Check here bluecross blueshield fed blue bariatric official portal step by step. Location: MO. *GP( @ r UQ T9 Centers for Bariatric Surgery. National Average: $19,450. Coronary artery disease. If this is the case and you find a second surgery or procedure is needed, you might find that Blue Cross Blue Shield does provide coverage for a second surgery as long as you followed post-operative instructions and made lifestyle changes for success as well as turned to the bariatric surgeon and other sources for additional help.
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