blue cross blue shield bariatric surgery requirements 2022

endobj *GP( @ r UQ T9 Does Blue Cross Blue Shield of Alabama (BCBS) cover bariatric surgery? %PDF-1.6 % Revisions are covered if there is documentation of a failure secondary to a surgical complication. 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 . endobj Gastric Sleeve Surgery. Weight loss surgery is an effective treatment for morbid obesity. comply with pre- and post-surgical requirements Note: . 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, Blue Cross Blue Shield does offer coverage if your primary procedure does not produce the expected results. Blue Cross Blue Shield Association. 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. 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. We lowered the age we will begin covering weight-loss (bariatric) surgery for members to age 16. This is the medical billing code for gastric bypass surgery. *GP( @ r UQ T9 <> Morbid GQ^3>EtB0Pq*%`4)}S[]6 Va.sMnLdEcobqV}un s^-(w=f(o`?~~qC 7KPDBBERo>(^Bg,{8uWU tASR/a^_NX,vfUrOG(!YW_^H View the medical and drug authorization tables to determine when to request an authorization. 2 0 obj Weight Loss Surgery Insurance Appeal Letter & The Appeals Process, Recovery from Gastric Sleeve What to Expect from Day 1. 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 . Many patients who have inadequate or no insurance coverage for weight loss . there are documented recurrent or chronic rashes, infections, cellulitis, or non-healing ulcers, that do . Most PDF readers are a free download. 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. 0 endstream endobj 749 0 obj <. 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. (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. 4510 13th Ave. S. Starting Weight: 258 lbs. *GP( @ r UQ T9 *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. Directory ofBlue Distinction Centers and Blue Distinction Centers+ for Bariatric Surgery, Program Selection Criteria For Bariatric Surgery. 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. This policy version was replaced October 31, 2022. . *GP( @ r UQ T9 Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. If you have surgery, some private Medicare Supplement plans might cover some out-of-pocket costs not covered under Original Medicare pays, such as . and comply with all phases of pre- and post-operative care and is committed to long-term post-operative follow-up requirements; and . Any bariatric surgeon that accepts Blue Cross Blue Shield of Michigan will know where the surgery has to take place. Bariatric surgery may be indicated for patients 18 to 60 years of age. 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 . In general, 20% to 30% above "ideal" bodyweight, according to standard life insurance tables, constitutes obesity. *GP( @ r UQ T9 ZIc$"NmZ;} AdN5N`]_c[K2~3[p'X9 YM"]0*=|. Blue Cross and Blue Shield of Oklahoma, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association . If your policy covers gastric bypass then it should cover other bariatric surgery procedures as well. *GP( @ r UQ T9 Covered gastric restrictive or malabsorpive procedures must be performed in an approved facility with one of the following accreditations, https://www.facs.org/search/bariatric-surgery-centers. endstream endobj startxref *GP( @ r UQ T9 hbbd```b`` "HE`Z09D|&&_IO`" H2nb3w Z'[A$)X}L?o F_ % *GP( @ r UQ T9 patient education. 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. Bariatric surgery in patients with diabetes and body mass index less than 35 kg/m 2. Does Blue Cross Blue Shield of Alabama (BCBS) cover bariatric surgery? Arch Surg 2009; 144(12):1150-5. Weight loss surgery is an effective treatment for morbid obesity. *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. *GP( @ r UQ T9 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 Medicaids Criteria for Weight Loss Surgery Coverage. This site complies with the HONcode standard for trustworthy health information: Verify here. Section 3. 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. 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. Learn about BCBS of Alabama's requirements for weight-loss surgery. endobj post-op. x?. Jja(6$R?_"\ :# 'c H:9 H MfG _w Y.7 Wv 9f7 g r hr UQ T9 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 If a patient is less than 18 years of age, a letter . Sometimes you will need to Read more *GP( @ r UQ T9 Last Review: December 2022 . Enteric fistula that does not close with bowel rest and nutritional support; Gastrogastric fistula associated with ulcers, gastroesophageal reflux disease (GERD) and weight gain; Disruption/anastomotic leakage of a suture/staple line; Band intolerance with obstructive symptoms (e.g. 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 . . Generally, any procedure that is considered experimental will not be covered. *GP( @ r UQ T9 *GP( @ r UQ T9 The site may also contain non-Medicare related information. Posted February 24, 2015. An Independent Licensee of the Blue Cross and Blue Shield Association. <>/Font<>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> *GP( @ r UQ T9 A new Global Period will not apply to a procedure meeting these requirements and reported with modifier 78. *GP( @ r UQ T9 <>>> Directory ofBlue Distinction Centers and Blue Distinction Centers+ for Bariatric Surgery, Program Selection Criteria For Bariatric Surgery. 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 Blue Cross of California is the trade name for Anthem BCBS so your criteria for weight loss surgery will be the same as it is here. 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 Effective May 01, 2023. 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). 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. endobj (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.
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