These centers have lower complication rates and fewer readmissions. The 2022 health plan premiums are available at the CalPERS. Rohit A Patel, MD, FACS, FASMBS | Cooper University Health Care endobj The letter should also state that the physician has evaluated the patients mental condition and he/she is fully prepared for the surgery. We removed the limit on covered non-sibling donors for transplant services . As a result, some centers require active participation in a formal weight reduction program that includes frequent documentation of weight, dietary regimen, and exercise. 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) . Page 18. *GP( @ r UQ T9 1 0 obj Revised: July 2022. 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. Typically, if you paid cash for the procedure ongoing lap band fills will not be covered by insurance. *GP( @ r UQ T9 rvYWDgg!MxV Blue Cross Blue Shield of Minnesota Medical Policy Torrance Bariatric Institute provides expert weight loss procedures for patients looking for bariatric surgery in Torrance and surrounding areas. We recommend that you only use this publication in conjunction with the current year's health premium rate schedule and EOCs. If you are a Highmark member, please review and discuss any questions regarding medical policies with your treating provider and refer to your specific . PDF 2022 Bariatric Surgery PDF 2022 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus A 6 0 obj ObesityCoverage strongly feels that morbid obesity is a disease and every insurance company should cover these life saving procedures. *GP( @ r UQ T9 The site may also contain non-Medicare related information. Please refer to the criteria listed below for genetic testing. We are on a mission to help educate millions the benefits of weight loss 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 . If your policy covers gastric bypass then it should cover other bariatric surgery procedures as well. Last Review: December 2022 . In addition, some sites may require you to agree to their terms of use and privacy policy. Any bariatric surgeon that accepts Blue Cross Blue Shield of Michigan will know where the surgery has to take place. File Name: bariatric_ surgery 5/1983 . 1202 0 obj <> endobj ;.SovgPmc0u Ut9p+o1)ddT,c2MXy`PO;V kFXn^n1=u C5UL|efWaXenAFKua{ %,U(>t~;xL*[lMfl/$"Rg: >ArMT+&9!-Aa(=Xj _i5j)tpJh$D':uZ;yz.1KLLF 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. <>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 17 0 R 18 0 R 19 0 R 20 0 R 21 0 R 22 0 R 23 0 R 24 0 R 25 0 R 26 0 R 27 0 R 28 0 R 29 0 R 30 0 R 31 0 R 32 0 R 33 0 R 34 0 R 35 0 R 36 0 R 37 0 R 38 0 R 39 0 R] /MediaBox[ 0 0 960 540] /Contents 16 0 R/Group<>/Tabs/S/StructParents 1>> or 100% over ideal weight or a body mass index (BMI) of at least 40 or a BMI of 35 with comorbidities. 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. *GP( @ r UQ T9 Blue Cross Blue Shield of North Dakota is an independent licensee of the Blue Cross Blue Shield Association, serving residents and business in North Dakota. Before calling make sure you see our questions to ask before calling your insurance company. The following bariatric procedures may be considered medically necessary for the surgical treatment of morbid obesity whenALLof the selection criteria are met. What is a Weight Loss Seminar? (The individual has attained Tanner 4 pubertal development and final or near-final adult height (e.g., 95 % or greater) of adult stature); The individual is morbidly obese defined as a BMI greater than 50 kg/m2 or severely obese defined as a BMI greater than 40 kg/m2 with. *GP( @ r UQ T9 Wellmark Blue Cross and Blue Shield is an independent licensee of the Blue Cross and Blue Shield . However, since Blue Cross Michigan requires a Center of Excellence, using an in-network surgeon is recommended. Bariatric Surgery | Blue Cross and Blue Shield of Illinois - BCBSIL endobj <> In addition, some sites may require you to agree to their terms of use and privacy policy. 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. 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 . IMPORTANT REMINDER . Sleeve gastrectomy is an eligible procedure as a first stage of a two-stage procedure or as a sole definitive procedure; Laparoscopic adjustable gastric banding using an FDA approved adjustable gastric band: Laparoscopic adjustable banding is an eligible procedure ONLY when a contraindication to biliopancreatic bypass with duodenal switch, Rou-en-Y gastric bypass, and sleeve gastrectomy is documented in the medical record. Bariatric Surgery Which Procedure Is Best? *GP( @ r UQ T9 *GP( @ r UQ T9 PPO outpatient services do not require Pre-Service Review. 2019 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus. In general, 20% to 30% above "ideal" bodyweight, according to standard life insurance tables, constitutes obesity. This new site may be offered by a vendor or an independent third party. 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 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 Blue Cross and Blue Shield Service Benefit Plan Surgical Procedures FBF22.05b.1 Page 3 of 5 1/1/2020 Benefits for the surgical treatment of morbid obesity, performed on an inpatient or outpatient basis, are subject to the pre-surgical requirements listed below. endobj Blue Distinction Centers for Bariatric Surgery | Blue Shield of CA G-24-054 - Highmark stream The individual's understanding of the procedure and ability to participate and comply with life-long follow-up and the life-style changes (e.g., changes in dietary habits, and beginning an exercise program) are necessary to the success of the procedure. Covered gastric restrictive or malabsorpive procedures must be performed in an approved facility with one of the following accreditations, https://www.facs.org/search/bariatric-surgery-centers. *GP( @ r UQ T9 (2009) Preoperative weight loss before bariatric surgery. Blue Cross Blue Shield of Michigan covers weight loss surgery. A representative will contact you within one to two business days to help you schedule an appointment. This new site may be offered by a vendor or an independent third party. *GP( @ r UQ T9 Returning Shopper? 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. To view this file, you may need to install a PDF reader program. *GP( @ r UQ T9 of the selection criteria are met. [oH:kv=(@me_Wu C w/n7}3N$*hX|! endobj The individual's medical record documentation should indicate that all psychosocial issues have been identified and addressed; Psychological evaluation documentation must be within the last year; Individual selection is a critical process requiring psychiatric evaluation and a multidisciplinary team approach. To find out which services are covered under your policy at any facility, please call the customer service phone number on the back of your Blue Cross and Blue Shield of Oklahoma member ID card. It is important to know that your employer can typically opt-out of weight loss surgery insurance coverage for their employees policies. All rights reserved. The individual is morbidly obese and is at least 18 years of age. However, there is a lack of evidence on the optimal timing, intensity and duration of nonsurgical attempts at weight loss, and whether a medical weight loss program immediately preceding surgery improves outcomes; The individual must complete a psychological evaluation performed by a licensed mental health care professional and be recommended for bariatric surgery. %PDF-1.6 % *GP( @ r UQ T9 ANYONE *GP( @ r UQ T9 Individual outcomes may vary. xVk@~7=nBvcBP`k2OMp}Nn%04)X?P0B3MHJZ+cHf\|&r4\1oZ) "M ALL Access Your Payment Options. Bariatric Surgery . Our Philosophy; . Weight loss surgery is an effective treatment for morbid obesity. Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. All rights . 5 0 obj Surgery Date: 03/24/2015. Pd-&mm@!U+V]]h)z'/6;]oB=u[_J^H\nt`Q[Lo{Kxcp=s}Fe?L&`mq8,!PvokA_EP%>O[ s{jSAx 6&mWwOoZLzwd\^d^77ojxmoF=+g^iKE*f{v+o'([~lr|Xj}h.]VF74;UBQ>Bw%}|LMWo/+wzW#9+O[0*9)/}b5FA@V:Kb6!eM_O$WBwg]5@uE Blue Cross Blue Shield of North Carolina NC 3,700,000 4/1/2021 link X X X Anthem Blue Cross Blue Shield GA 3,600,000 8/13/2020 link X X CareFirst Blue Cross Blue Shield DC, MD, northern VA 3,500,000 7/1/2020 link X X (6 consecutive months w/in past 2 years) Anthem Blue Cross Blue Shield OH 3,400,000 8/13/2020 link X X Northeast Georgia Medical Center (NGMC) offers a variety of surgical and nonsurgical weight-loss options and is an Anthem Blue Cross Blue Shield Blue Distinction Center for Bariatric Surgery. FEP Blue Focus Prior Approval List - Effective January 1, 2023 . blue shield bariatric surgery requirements - Blucross Blueshield 2022 Georgia State Health Benefit Plan to Cover Weight-Loss Surgery in 2022 Blue Cross and Blue Shield's Federal Employee Program Benefit Plans Brochures and Forms Webpage . National Average: $19,450. *GP( @ r UQ T9 endobj endobj Blue Cross Blue Shield Association. *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. In general, 20 percent to 30 percent above 'ideal' bodyweight, according to standard life insurance tables, constitutes obesity. If you are planning on having any of the above weight loss procedures and you meet the pre-approval requirements, you should schedule an initial meeting with your Bariatric surgeon of choice who will give you an overview of the process as he/she reviews your health history to confirm eligibility. *GP( @ r UQ T9 Body Mass Index (BMI) of 40 or greater OR. Laparoscopic Gastric Bypass This procedure is performed laparoscopically, an approach that is less invasive than open incision surgery, where the surgeon staplesthe top portion of the stomach to separate it from the bottom part to create a small stomach pouch thatrestricts food intake the number of calories and nutrients the body absorbs. 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). endobj One option is Adobe Reader which has a built-in reader. 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. Any bariatric surgeon that accepts Blue Cross Blue Shield of Michigan will know where the surgery has to take place. The individual 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. *GP( @ r UQ T9 *GP( @ r UQ T9 Medicaids Criteria for Weight Loss Surgery Coverage. 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. Centers for Bariatric Surgery. 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. Accept Read More, Anthem BCBS Requirements for Weight Loss Surgery, 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. 1226 0 obj <>/Filter/FlateDecode/ID[<85F633C9C5D3CC438248A4BA5CE2CCC7>]/Index[1202 37]/Info 1201 0 R/Length 115/Prev 386164/Root 1203 0 R/Size 1239/Type/XRef/W[1 3 1]>>stream 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! *GP( @ r UQ T9 *GP( @ r UQ T9 To speak to someone directly, please call 1-773-702-1618. 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 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. Benefits Section 5(c). *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. endstream endobj We lowered the age we will begin covering weight-loss (bariatric) surgery for members to age 16. PDF REIMBURSEMENT POLICY Weight Management Care - Blue Cross MN *GP( @ r UQ T9 Pre-Cert/Pre-Auth (In-Network) - CareFirst 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; Attainment or near-attainment of physiologic/skeletal maturity at approximately, age 13 in girls and 15 for boys. To qualify for coverage of weight loss surgery, your policy must include coverage. *GP( @ r UQ T9 The member must meet all requirements. 24/7 online access to account transactions and other useful resources, help to ensure that your account information is available to you any time of the day or night. *GP( @ r UQ T9 *GP( @ r UQ T9 Blue Cross covers services for the treatment of obesity, weight management, eating disorders, nutrition and physical activity counseling. 0 However, your deductible and out of pocket costs may be significantly lower if you do. *GP( @ r UQ T9 Anthem BCBS may cover weight loss surgery as long as your policy does not specifically exclude coverage. 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. Diagnosis of Morbid obesity, defined as. 2022 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option Section 5. *GP( @ r UQ T9 Is a Second Weight Loss Surgery Covered if Gastric Banding Didnt Work? *GP( @ r UQ T9 InterQual criteria is used to evaluate whether a medical procedure or equipment . MyBlue offers online tools, resources and services for Blue Cross Blue Shield of Arizona Members, contracted brokers/consultants, healthcare professionals, and group benefit administrators. *GP( @ r UQ T9 <> ZIc$"NmZ;} AdN5N`]_c[K2~3[p'X9 YM"]0*=|. Blue Distinction Centers and Blue Distinction Centers+ for Bariatric Surgery offer a full range of bariatric surgery care, including: surgical. *GP( @ r UQ T9 If the individual does not meetALLof the selection criteria for bariatric surgery, the procedure will be denied as not medically necessary. "Our comprehensive program helps patients [] . *GP( @ r UQ T9 Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. Anthem BCBS - Requirements for Weight Loss Surgery *GP( @ r UQ T9 2022 Policy Documents. Bariatric Surgery | BCBSND *GP( @ r UQ T9 773 0 obj <>/Filter/FlateDecode/ID[<675B09CE55CCC14F9AD95E27B755F731>]/Index[748 42]/Info 747 0 R/Length 117/Prev 507134/Root 749 0 R/Size 790/Type/XRef/W[1 3 1]>>stream *GP( @ r UQ T9 and patient education. View Medical Policies | Excellus BlueCross BlueShield
