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. Bariatric surgery is performed to treat morbid . 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). hbbd```b`` "HE`Z09D|&&_IO`" H2nb3w Z'[A$)X}L?o F_ endobj Blue Cross Michigan can be contacted here or at the customer service number provided on the back of your enrollee ID card. *GP( @ r UQ T9 *GP( @ r UQ T9 ALL *GP( @ r UQ T9 Returning Shopper? Origination: Last Review: Description of Procedure or Service . Directory of Blue Distinction Centers and . Bariatric Surgery Bariatric surgery is performed to treat morbid (clinically severe) obesity. Benefits Section 5(c). Bariatric and Transplant care benefits are limited to services provided in a Blue Distinction Center (see pages 62 and 66 ). InterQual criteria is used to evaluate whether a medical procedure or equipment . of the selection criteria are met. External link You are leaving this website/app (site). BCBS of Texas Criteria for Weight Loss United Healthcares Criteria For Weight Loss Surgery Coverage, Anthem BCBS Requirements for Weight Loss Surgery, Medicares Criteria For Weight Loss Surgery Coverage. 14 0 obj Blue Cross Blue Shield of North Dakota is an independent licensee of the Blue Cross Blue Shield Association, serving residents and business in North Dakota. In fact, most of the Blue Cross Blue Shield network has some sort of coverage for weight loss surgery. Height: 5 feet 6 inches. patient education. Medical Policies A-Z. *GP( @ r UQ T9 endobj @h23Begj!b4ZJ2}Y*bPc6d 5d 05dD/Br,Fsr#0Yi^kRsTCx aEt! B#UVjHJ)Uc_;(T;ZAYQ}_B4UC3{mo stream It is at this point that an insurance verification coverage process is conducted as well as pre-operative testing. *GP( @ r UQ T9 Member meets one of the following BMI requirements and has been at that BMI for a minimum of 2 years: o BMI over 40 o BMI . 1J-z](5K+XkXU)zc+2gUnRsXuQ@t>icv- {7V}*ymha.JS10NL](wnj`"5c+8L5TwB0mgbP{C]Z#H4:s PCD4N0"Pz}KP7A@mDY*/yiI @Z22*;/-"i1-mhqe,@e*De)KW8vYiI @Z22*;/-"iq@M&, e * PY$(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! 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. These centers have lower complication rates and fewer readmissions. *GP( @ r UQ T9 *GP( @ r UQ T9 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 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. endstream endobj 749 0 obj <. 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. Contact 866-773-2884 for authorization regarding treatment. . 15 0 obj 13 0 obj ANYONE Blue Distinction Criteria. 2022 Bariatric Surgery Coverage Announcements Summary . <> and For further inquiries, contact Blue Cross Blue Shield of Louisiana HMO through their official website https://www.bcbsla.com or call them using the numbers behind your ID card (1-800-495-2583) to get accurate costs on various medical procedures they might be providing cover for based on price and location. 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 *GP( @ r UQ T9 hb``` cc`aX` r0(i``ZG!'f{ Morbid obesity is defined as a condition of consistent and uncontrollable weight gain that is characterized by. 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. 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. 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. 12 0 obj *GP( @ r UQ T9 One of the most common questions asked by prospective patients is, "Will my insurance cover Weight Loss Surgery, and what requirements do I have to meet in order to qualify?". Register for MyBlue. <> R. (,`)BAk" If you are a Highmark member, please review and discuss any questions regarding medical policies with your treating provider and refer to your specific . This new site may be offered by a vendor or an independent third party. 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. 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 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. Check here bluecross blueshield fed blue bariatric official portal step by step. 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. 18 years of age (special consideration if under 18 with severe morbid obesity and special circumstances). So, to find out if your policy includes coverage, please talk directly to Blue Cross Michigan. 6Nale{Aq;7Qy=1(tg?fd``{ X'@``} QT` So we are happy to report that manyAnthem BCBS policies cover weight loss surgery. (The individual has attained final or near-final adult height (e.g., 95 percent or greater) of adult stature); The individual is morbidly obese defined as; Severely obese defined as a BMI greater than 40 kg/m. *GP( @ r UQ T9 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. Liq V8 K+%w\R,XXXYY&1]yxh~C%k.2 MeOaLd9 sG@Afd`}w U Here you will find information for assessing coverage options, guidelines for clinical utilization management, practice policies, the provider manual and support for delivering benefits to our members. Morbid obesity is defined as a body mass index (BMI) greater than 40 kg/m2 or a BMI greater than 35 kg/m2 with associated complications including, but not limited to, diabetes, hypertension, or obstructive sleep apnea. *GP( @ r UQ T9 Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. *GP( @ r UQ T9 Understanding Weight-Loss Surgery: Is it for you? *GP( @ r UQ T9 External link You are leaving this website/app (site). Provider Discharge Form. endstream endobj startxref *GP( @ r UQ T9 ; Bariatric surgery, falls into two general categories: 1) gastric-restrictive procedures that create a small gastric *GP( @ r UQ T9 Page 18. Starting in Fall of 2022, FEP Blue Focus members can receive a . If a patient is less than 18 years of age, a letter . endobj Contact information for your Anthem BCBS is listed below. *GP( @ r UQ T9 These centers have lower complication rates and fewer readmissions. *GP( @ r UQ T9 endobj *GP( @ r UQ T9 *GP( @ r UQ T9 BCBS New York Excellus Weight Loss Surgery Kaiser Permanente Covers Weight Loss Surgery. Bariatric Journal is a leading publication for bariatric surgery guides and information. *GP( @ r UQ T9 Below, you'll learn what factors into the cost of . accredited by the metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Request an Appointment. Individual outcomes may vary. 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. Morbid In order to be approved by Horizon Blue Cross Blue Shield of New Jersey for bariatric surgery in the United States, you must meet the following criteria: Be Age 18 of age or older. *GP( @ r UQ T9 1238 0 obj <>stream Greater than or equal to 18 years; or b. *GP( @ r UQ T9 2 0 obj *GP( @ r UQ T9 *GP( @ r UQ T9 Revisions to the surgery are covered by Blue Cross Michigan. of the selection criteria for bariatric surgery, the procedure will be denied as not medically necessary. *GP( @ r UQ T9 *GP( @ r UQ T9 endstream To view this file, you may need to install a PDF reader program. NOTICE: This policy contains information which is clinical in nature. Check with your employer to find out how much they contribute toward your premium. Open Gastric Bypass Surgery This procedure is rare and only performed under particular medical circumstances. The individual is morbidly obese and is at least 18 years of age. However, since Blue Cross Michigan requires a Center of Excellence, using an in-network surgeon is recommended. 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. *GP( @ r UQ T9 This is the medical billing code for gastric bypass surgery. *GP( @ r UQ T9 An Independent Licensee of the Blue Cross and Blue Shield Association. *GP( @ r UQ T9 Internal Medical Policy Committee 1-20-2022 Revision with coding updates; . bariatric surgery would be considered a component of and incidental to the primary . *GP( @ r UQ T9 Inpatient Facility Average: $25,925. PPO outpatient services do not require Pre-Service Review. Primary Care Physician's Letter. *GP( @ r UQ T9 *GP( @ r UQ T9 Any bariatric surgeon that accepts Blue Cross Blue Shield of Michigan will know where the surgery has to take place. Sometimes you will need to Read more Blue Cross and Blue Shield is an association of . aDonHg$z3C:?7$SCKbcT1,Q,b4Ypm15Z;x1Fa1Aha&PF+w:#7a8s /[F?&a18+Ah^Pf%&TundvhihFm{6TmO{7.[wNQyg )w ;Er'(P$x=E'(P$z}E'(eaE*;*E#lPP0Bv#G((`7BA 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. %PDF-1.5 5 0 obj Bariatric surgery (any procedure) for patients with a BMI < 35 kg/m 2 including but not limited to solely as a cure for type 2 diabetes mellitus; . Blue Cross Blue Shield Of Michigan Pre-Approval Requirements. . Facilities designated as Blue Distinction and Blue . Location: MO. *GP(:&. stream This website uses cookies to improve your experience. National Range: $11,550 - $27,325+. *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. If a patient is less than 18 years of age, a letter should be provided from a physician stating that surgery may prove risky if withheld for a later date. 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. 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. hbbd```b``~"gHR ,,"G3`q+0%XW8gC3kIG vD2u 6 Hf`bd`20R x g Please consult professional medical advice before pursuing any treatment. 4510 13th Ave. S. 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 The patient meets one of the following age requirements: a. <> *GP( @ r UQ T9 *GP( @ r UQ T9 Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. These may include: The weight loss surgery should have been prescribed by a physician other than the operating surgeon. Skilled Nursing Facility and Inpatient Rehabilitation Fax Form. The Center of Excellence should also hold a certification by the American Society for Bariatric Surgery as a bariatric surgery Center of Excellence. 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 . endstream 8 0 obj Laparoscopic adjustable gastric banding using an FDA-approved adjustable gastric band is a second-tier procedure that shouldONLYbe performed when extenuating circumstances exist. Outpatient Facility Average: $16,150. vomiting, esophageal spasm); Band slippage and/or prolapse that cannot be corrected with manipulation or adjustment; Stricture/stenosis with dysphagia, solid food intolerance and/or severe reflux; Non-absorption resulting in hypocalcemia or malnutrition; Weight loss of 20 percent or more below ideal body weight. 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. 2022-05-19: Cosmetic / Reconstructive Surgery Ablation/Denervation Techniques for Knee Pain Open a PDF 7.01.100: 08/16/2022: Bone & Joints (Orthopedic) Acupuncture and Auricular Electrostimulation Open a PDF 8.01.20: 2023-04-17: Alternative Medicine *GP( @ r UQ T9 endobj 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). To speak to someone directly, please call 1-773-702-1618. Section 3. Review: Prosper Healthcare Lending Should You Choose it for Bariatric Surgery Financing? 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. 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. 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 . *GP( @ r UQ T9
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