blue cross blue shield bariatric surgery requirements 2022

• 8 September 2023

InterQual criteria is used to evaluate whether a medical procedure or equipment . Blue Cross Michigan does not cover procedures considered investigational. Coverage Policy Manual - Arkansas Blue Cross and Blue Shield Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. Benefits Section 5(c). 4. endobj Clinical Guidelines - Horizon NJ Health PDF Bariatric Surgery Selection Criteria - Blue Cross Blue Shield Association To obtain a copy of the health premium TEC . Typically, if you paid cash for the procedure ongoing lap band fills will not be covered by insurance. Blue Cross and Blue Shield is an association of . Many who have sustained their weight loss through Bariatric surgery have reported a significant improvement in their overall health and lifestyle. <> endobj PDF Medical Management of Obstructive Sleep Apnea Syndrome - Blue Cross and endstream endobj 749 0 obj <. 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. Active Participation and Documentation of non-surgical methods of weight loss. O *GP( @ r UQ T9 This site complies with the HONcode standard for trustworthy health information: Verify here. In fact, most of the Blue Cross Blue Shield network has some sort of coverage for weight loss surgery. Bariatric Journal Editor. This is the medical billing code for gastric bypass surgery. 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). *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. Reviewed: July 2022 . PDF REIMBURSEMENT POLICY Weight Management Care - Blue Cross MN Full coverage for a weight loss surgery procedure will be provided to a patient with a Body Mass Index (BMI) over 40. 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. Panniculectomy is considered medically necessary for the individual who meets the following criteria: . NOTICE: This policy contains information which is clinical in nature. *GP( @ r UQ T9 Blue Distinction Centers for Bariatric Surgery, along with the Blue Distinction . Open Gastric Bypass Surgery This procedure is rare and only performed under particular medical circumstances. I have Anthem Blue Cross Blue Shield through my husband's job here in MO and they cover "medically necessary" revisions with a BMI over 40 or over 35 . Weight Loss Surgery and the Insurance Process Blue Distinction Criteria. %%EOF Our Philosophy; . *GP( @ r UQ T9 *GP( @ r UQ T9 Individual outcomes may vary. 2. Page 18. External link You are leaving this website/app (site). Arch Surg 2009; 144(12):1150-5. To qualify for coverage of weight loss surgery, your policy must include coverage. stream *GP( @ r UQ T9 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. Yes, weight loss surgery must be done at a. This new site may be offered by a vendor or an independent third party. <>/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>> endobj hbbd```b``~"gHR ,,"G3`q+0%XW8gC3kIG vD2u 6 Hf`bd`20R x g The Horizon Info Submission Template for Practitioners is another possible you can use to makes updates to your purveyor data in our systems. endobj accredited by the metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, . One option is Adobe Reader which has a built-in reader. *GP( @ r UQ T9 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 In addition, some sites may require you to agree to their terms of use and privacy policy. 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 Will Your Stomach Stretch after Gastric Sleeve Surgery? Bariatric Surgery . *GP( @ r UQ T9 <> QiP^0#jfc~%M/8 2E .vP[mc~9} Bariatric Journal is the leading bariatric surgery resource site for patients. 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. As a result, some centers require active participation in a formal weight reduction program that includes frequent documentation of weight, dietary regimen, and exercise. If you are a Highmark member, please review and discuss any questions regarding medical policies with your treating provider and refer to your specific . If a patient is less than 18 years of age, a letter . 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. Directory of Blue Distinction Centers and . 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 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. Gastric Sleeve Surgery. n+b%M@9A9 @@uP3\` 44L3vt M, D0u`BYEH28s1bi30cs7 *&1g *GP( @ r UQ T9 Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. *GP( @ r UQ T9 *GP( @ r UQ T9 Blue Cross and Blue Shield's Federal Employee Program Benefit Plans Brochures and Forms Webpage . Corporate Medical Policy Bariatric Surgery - Blue Cross NC Blue Cross Blue Shield Association is an association of independent Blue Cross and Blue Shield companies. This new site may be offered by a vendor or an independent third party. 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. *GP( @ r UQ T9 Log In to the Shopping Cart, Need to Make a Payment? 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. stream So we are happy to report that manyAnthem BCBS policies cover weight loss surgery. 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. 18 years of age (special consideration if under . . *GP( @ r UQ T9 These may include: The weight loss surgery should have been prescribed by a physician other than the operating surgeon. If your policy covers gastric bypass then it should cover other bariatric surgery procedures as well. However, your deductible and out of pocket costs may be significantly lower if you do. Bariatric Surgery | Blue Cross and Blue Shield of Texas - BCBSTX 0 . Access Your Payment Options. 1 0 obj *GP( @ r UQ T9 *GP( @ r UQ T9 Bariatric surgery may be indicated for patients 18 to 60 years of age. @h23Begj!b4ZJ2}Y*bPc6d 5d 05dD/Br,Fsr#0Yi^kRsTCx aEt! Learn more about weight loss surgery at Rocky Mountain Associated Physicians www.RMAP.com (801) 268-3800. bariatric surgery. 10 0 obj Based on our data, the target fair price for a laparoscopic hysterectomy is $12,250, whether you have health insurance or not. PDF FEP Blue Focus Prior Approval List - Premera Blue Cross We are on a mission to help educate millions the benefits of weight loss surgery. *GP( @ r UQ T9 *GP( @ r UQ T9 <> Blue Distinction Specialty Care To speak to someone directly, please call 1-773-702-1618. 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 . endobj 8 0 obj 4510 13th Ave. S. Blue Cross PPO, Blue Cross-Blue Shield* and Cigna PPO. endobj FEP Blue Focus Prior Approval List - Effective January 1, 2023 . Services Provided by a Hospital or Other Facility, and Ambulance Services Blue Distinction Specialty Care . 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. To view this file, you may need to install a PDF reader program. Effective May 01, 2023. stream R. (,`)BAk" F(PP0B/_Y#T3RF(PP0B4NOCD bp Bariatric Surgery for Morbid Obesity. *GP( @ r UQ T9 No. | Any bariatric surgeon that accepts Blue Cross Blue Shield of Michigan will know where the surgery has to take place. Rohit A Patel, MD, FACS, FASMBS | Cooper University Health Care This new site may be offered by a vendor or an independent third party. This website uses cookies to improve your experience. <> Laparoscopic adjustable gastric banding is contraindicated for individuals aged 17 years or under. and patient education. <> All rights reserved. *GP( @ r UQ T9 Please contact BCBS of Michigan directly to find out if they offer coverage for a second procedure. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. They are: This list is not comprehensive. 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.

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