blue cross blue shield bariatric surgery requirements 2022

*GP( @ r UQ T9 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. 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. Which Bariatric Surgery is Best? Medicaids Criteria for Weight Loss Surgery Coverage. National Range: $11,550 - $27,325+. For high BMI individuals in whom the duodenal switch may be difficult, it is reasonable to do a sleeve gastrectomy as the first stage of an intended two-stage duodenal switch. endobj or 100 percent over ideal weight or a body mass index (BMI) of at least 40 or a BMI of 35 with comorbidities. *GP( @ r UQ T9 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. Horizon Data Submission Template - Horizon Blue Cross Blue Shield of Blue Cross and Blue Shield's Federal Employee Program Benefit Plans Brochures and Forms Webpage . <>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 960 540] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 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. 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. 1 0 obj Blue Cross and Blue Shield of Oklahoma, aDivision 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). *GP( @ r UQ T9 10 0 obj endstream Referral for Applied Behavioral Analysis (ABA) Assessment, Initiation and Continuation Request Form for Applied Behavior Analysis. 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. The BDC for Bariatric Surgery program evaluates facilities with bariatric surgery programs that treat adult patients 18 years or older, in Comprehensive Center (with or without an on- site ICU) and Ambulatory Surgery Center (ASC) settings. Learn about BCBS of Alabamas requirements for weight-loss surgery. Blue Cross and Blue Shield of Illinois, aDivision 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). *GP( @ r UQ T9 n+b%M@9A9 @@uP3\` 44L3vt M, D0u`BYEH28s1bi30cs7 *&1g GQ^3>EtB0Pq*%`4)}S[]6 Va.sMnLdEcobqV}un s^-(w=f(o`?~~qC 7KPDBBERo>(^Bg,{8uWU tASR/a^_NX,vfUrOG(!YW_^H Blue Cross Michigan can be contacted here or at the customer service number provided on the back of your enrollee ID card. No specific information regarding the requirement of an in-network surgeon is available. 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 . 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. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means Will Your Stomach Stretch after Gastric Sleeve Surgery? This new site may be offered by a vendor or an independent third party. We'll assume you're ok with this, but you can opt-out if you wish. For more information, please contact SKYGEN USA 1-855-878-5368. *GP( @ r UQ T9 If you have surgery, some private Medicare Supplement plans might cover some out-of-pocket costs not covered under Original Medicare pays, such as . 2023 Blue Cross Blue Shield of North Dakota, Please wait while your form is being submitted, Directory Validation Instructions (No Surprises Act), Recredentialing & Credentialing Applications. MyBlue offers online tools, resources and services for Blue Cross Blue Shield of Arizona Members, contracted brokers/consultants, healthcare professionals, and group benefit administrators. In general, 20% to 30% above "ideal" bodyweight, according to standard life insurance tables, constitutes obesity. 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. Weight loss surgery is an effective treatment for morbid obesity. To view this file, you may need to install a PDF reader program. Location: MO. *GP( @ r UQ T9 If you have symptoms of an urgent nature, please call your doctor or go to . a Body Mass Index (BMI) greater than 40. (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. 3 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 of the selection criteria are met. *GP( @ r UQ T9 *GP( @ r UQ T9 *GP( @ r UQ T9 *GP( @ r UQ T9 endobj *GP( @ r UQ T9 We removed the limit on covered non-sibling donors for transplant services . *GP( @ r UQ T9 *GP( @ r UQ T9 <>/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>> 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. *GP( @ r UQ T9 *GP( @ r UQ T9 Consult and recommendation from a weight loss surgeon. Check here bluecross blueshield fed blue bariatric official portal step by step. *GP( @ r UQ T9 <> 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. *GP( @ r UQ T9 Coverage Policy Manual - Arkansas Blue Cross and Blue Shield Fargo, N.D., 58121. About Us. <> 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. <> October 2017. endobj Medical Policy Update is a monthly newsletter for the health care providers who participate in our networks and submit claims to Highmark Blue Cross Blue Shield of Western New York (Highmark BCBSWNY) using the appropriate HIPAA transactions or claim forms as required by Highmark BCBSWNY.This publication focuses only on medical policy and claims administration updates, including coding . Corporate Medical Policy Bariatric Surgery - Blue Cross NC *GP( @ r UQ T9 Copyright 2022 Bariatric Journal, All Rights Reserved. Last Review: December 2022 . Medical policies for providers | Wellmark FPUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUa _AUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUU=8$ /L DG Blue Distinction Specialty Care *GP( @ r UQ T9 Understanding Weight-Loss Surgery: Is it for you? 0 This new site may be offered by a vendor or an independent third party. 2019 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus. Blue Distinction. *GP( @ r UQ T9 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. It is important to know that your employer can typically opt-out of weight loss surgery insurance coverage for their employees policies. 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. %PDF-1.5 endobj endobj Rohit A Patel, MD, FACS, FASMBS | Cooper University Health Care Bariatric surgery may be indicated for patients 18 to 60 years of age. TEC . The duration of the weight loss program should have been at least twelve consecutive months. accredited by the metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Provider Discharge Form. m4:TY=6uhKy+\W5nx` G;o\c0Va H }'H1hbX50aG@$GP0~ 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. Liq V8 K+%w\R,XXXYY&1]yxh~C%k.2 MeOaLd9 sG@Afd`}w U Access Your Payment Options. 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). Blue Cross Blue Shield Association. 748 0 obj <> endobj *GP( @ r UQ T9 Policies, Guidelines & Manuals. 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. This site complies with the HONcode standard for trustworthy health information: Verify here. Blue Cross Blue Shield of Michigan covers weight loss surgery. (2009) Preoperative weight loss before bariatric surgery. Inpatient Facility Average: $25,925. Access Your Payment Options. 5 0 obj The following are three types of weight loss procedures that are covered by BCBS Alabama. *GP( @ r UQ T9 This will depend on the type of policy you have purchased. stream endobj 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. To speak to someone directly, please call 1-773-702-1618. TTY users can call 1-877-486-2048. *GP( @ r UQ T9 All rights reserved. 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; 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. Representatives are available 24 hours a day, seven days a week. Skip to content. PDF Bariatric Surgery Selection Criteria - Blue Cross Blue Shield Association *GP( @ r UQ T9 Surgery Date: 03/24/2015. 18 years of age (special consideration if under 18 with severe morbid obesity and special circumstances). PDF 2023 Benefit Summary Book However, the following documentation must be submitted: Blue Cross Michigan has strict guidelines for the requirement of a Center of Excellence. *GP( @ r UQ T9 *GP( @ r UQ T9 BCBS of Michigan provides full coverage for bariatric procedures provided the patient meets the following requirements: The weight loss procedures covered by Blue Cross Michigan include: You can contact Blue Cross Blue Shield of Michigan to get detailed information regarding the procedures covered. %PDF-1.6 % 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 percent 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; A revision of a primary bariatric surgery procedure that has failed due to dilatation of the gastric pouch, dilated gastrojejunal stoma, or dilation of the gastrojejunostomy (GJ) anastomosis if the primary procedure was successful in inducing weight loss prior to the dilation of the pouch or GJ anastomosis, and the individual has been compliant with a prescribed nutrition and exercise program following the procedure; Replacement of an adjustable band if there are complications (e.g., port leakage, slippage) that cannot be corrected with band manipulation or adjustments; A conversion from an adjustable band to a sleeve gastrectomy, RYGB or BPD/DS for individuals who have been compliant with a prescribed nutrition and exercise program following the band procedure and have experienced complications that cannot be corrected with band manipulation, adjustments or replacement. Blue Cross Blue Shield of Louisiana HMO Bariatric Surgery In addition, some sites may require you to agree to their terms of use and privacy policy. Bariatric Surgery . 2022 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option Section 5. 18. 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. Blue Cross Blue Shield of Minnesota Medical Policy 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. BCBS of Alabama Bariatric Surgery: Requirements, Options, Cost, Denails 2 Blue Distinction Centers for Bariatric Surgery | Program Selection Criteria The Program uses updated Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) accreditation levels, which focus on site of service. endobj Does Blue Cross Blue Shield of Alabama (BCBS) cover bariatric surgery? Does Medicaid Cover Lap Band Surgery - MedicAidTalk.net *GP( @ r UQ T9 Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically. rvYWDgg!MxV The information you provide will enable us to assist you as efficiently as possible. Bariatric Surgery for Morbid Obesity. patient education. 13 0 obj website at www.calpers.ca.gov. 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; Weight loss of 20% or more below ideal body weight. *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 Contact 866-773-2884 for authorization regarding treatment. Returning Shopper? *GP( @ r UQ T9 Anthems can be contacted at1-866-293-2892. 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. In addition, some sites may require you to agree to their terms of use and privacy policy. Repeat or Revised Bariatric Surgical Procedures. Complications can include but are not limited to fistula, obstruction or disruption of a suture/staple line. Generally, any procedure that is considered experimental will not be covered. Learn about BCBS of Alabama's requirements for weight-loss surgery. Anthem BCBS - Requirements for Weight Loss Surgery If your policy covers gastric bypass then it should cover other bariatric surgery procedures as well. PDF Legend - American Society for Metabolic & Bariatric Surgery PDF BCBSM Medicare Advantage PPO Weight Loss Surgery Enhanced Benefit To view this file, you may need to install a PDF reader program. During the Realize Band procedure, two devices are implanted during surgery, and the surgeon injects saline into the port to tighten or loosen the band based on weight loss goal and physical reactions to the operation. *GP( @ r UQ T9 2 0 obj %%EOF ALL 3 0 obj <> <> Bariatric surgery should be performed in appropriately selected individuals by surgeons who are adequately trained and experienced in the specific techniques used and in institutions that support a comprehensive bariatric surgery program, including long-term monitoring and follow-up post-surgery. Blue Cross and Blue Shield of Oklahoma, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association . %%EOF 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. F(wG((|1]) Wellmark Blue Cross and Blue Shield is an independent licensee of the Blue Cross and Blue Shield . Weight Loss Surgery Insurance Coverage Criteria, The Pouch Reset Losing Weight After Weight, These 5 Habits = Weight Loss Surgery Success. Torrance Bariatrics Institute | Dr. Ramin Roohipour Section 3. Based on our data, the target fair price for a laparoscopic hysterectomy is $12,250, whether you have health insurance or not. 500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 MEDICAL COVERAGE POLICY | 4 (401) 274-4848 WWW.BCBSRI.COM Long-Limb Gastric Bypass (le, >150 cm) (CPT code 43847 - Gastric restrictive procedure with <> Blue Cross PPO, Blue Cross-Blue Shield* and Cigna PPO. QiP^0#jfc~%M/8 2E .vP[mc~9} *GP( @ r UQ T9 AZBlue - Medical Policies 1 0 obj 1J-z](5K+XkXU)zc+2gUnRsXuQ@t>icv- {7V}*ymha.JS10NL](wnj`"5c+8L5TwB0mgbP{C]Z#H4:s PCD4N0"Pz}KP7A@mDY*/yiI @Z22*;/-"i1-mhqe,@e*De)KW8vYiI @Z22*;/-"iq@M&, e * PY$(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! Directory ofBlue Distinction Centers and Blue Distinction Centers+ for Bariatric Surgery, Program Selection Criteria For Bariatric Surgery. 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.

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