*GP( @ r UQ T9 Individual outcomes may vary. Fargo, N.D., 58121. 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. 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). ,_*:1Ch_WpK3R6UYo gD_){6^9V0ljRoZY=;~lov'xmv'}y3-{lZjUTi:hnS: ]}}_v$j&m.~.?NIcWX*}pO=-f)/QeQ7vuT'UJ_\}Sj}NU~WOT}J"^ *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. 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. Surgeon: James Stephen Scott. *GP( @ r UQ T9 <>/Font<>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> *GP(:&. 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. *GP( @ r UQ T9 This policy version was replaced October 31, 2022. . *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. Laparoscopic adjustable gastric banding is contraindicated for individuals aged 17 years or under. Individuals 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 Blue Cross and Blue Shield of Minnesota reserves the right to revise, update and/or add to its medical policies at any time without notice. <> Bariatric Surgery Which Procedure Is Best? In general, 20% to 30% above "ideal" bodyweight, according to standard life insurance tables, constitutes obesity. *GP( @ r UQ T9 Do I Need To Attend? 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. Information regarding coverage of a second weight loss surgery is not available. Bariatric Surgery for Morbid Obesity. %%EOF Understanding Weight-Loss Surgery: Is it for you? Relevant medical documents need to be submitted as proof that previous weight loss programs tried by the patient did not help. Weight Loss Surgery Insurance Coverage Criteria, The Pouch Reset Losing Weight After Weight, These 5 Habits = Weight Loss Surgery Success. 1202 0 obj <> endobj 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 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). Weight Loss Surgery Insurance Coverage Criteria, The Pouch Reset Losing Weight After Weight, These 5 Habits = Weight Loss Surgery Success. <> endobj endobj Contact information for your Anthem BCBS is listed below. Request an Appointment. <>>> endobj IMPORTANT REMINDER . 1238 0 obj <>stream and comply with all phases of pre- and post-operative care and is committed to long-term post-operative follow-up requirements; and . The policy bulletins on this web site were developed to assist Highmark Blue Cross Blue Shield in administering standard plan benefits and do not constitute a description of plan benefits. 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. In fact, most of the Blue Cross Blue Shield network has some sort of coverage for weight loss surgery. Active Participation and Documentation of non-surgical methods of weight loss. 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. *GP( @ r UQ T9 The duration of the weight loss program should have been at least twelve consecutive months. The patient meets one of the following age requirements: a. xVk@~7=nBvcBP`k2OMp}Nn%04)X?P0B3MHJZ+cHf\|&r4\1oZ) "M Policies, Guidelines & Manuals. Referral for Applied Behavioral Analysis (ABA) Assessment, Initiation and Continuation Request Form for Applied Behavior Analysis. ZIc$"NmZ;} AdN5N`]_c[K2~3[p'X9 YM"]0*=|. (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. <> 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. Bariatric procedures not meeting the criteria as indicated in this policy are considered not medically necessary. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. *GP( @ r UQ T9 endstream 9 0 obj Centers for Bariatric Surgery. These centers have lower complication rates and fewer readmissions. Unsure which surgery is right for you? *GP( @ r UQ T9 TTY users can call 1-877-486-2048. endstream *GP( @ r UQ T9 ALL 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 . of the following criteria is met: Individual postoperative noncompliance negates the efficacy of revision or conversion surgery. 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 Provider Discharge Form. QHP Small Group Actual Policy Documents; . The individual is morbidly obese and is at least 18 years of age. *GP( @ r UQ T9 Typically, Blue Cross Blue Shield does offer coverage if your primary procedure does not produce the expected results. 4. ANYONE comply with pre- and post-surgical requirements Note: . Bariatric surgery may be indicated for patients 18 to 60 years of age. Returning Shopper? If the individual does not meet Patients in Georgia who are insured through the State Health Benefit Plan will now have coverage for weight-loss surgery beginning in 2022. *GP( @ r UQ T9 The following bariatric procedures may be considered medically necessary for the surgical treatment of morbid obesity when <>/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>> 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 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 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. It requires abdominal incisions of up to ten inches for patients with extremely high BMI, those with certain health conditions that make laparoscopic surgery risky, or those with significant scar tissue from other abdominal medicine that may prevent access to the surgical area. *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. 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. *GP( @ r UQ T9 *GP( @ r UQ T9 In addition, some sites may require you to agree to their terms of use and privacy policy. endobj Psychological Testing Form. If the procedure youd like to have is not listed on the approved list, it is likely not covered. Any bariatric surgeon that accepts Blue Cross Blue Shield of Michigan will know where the surgery has to take place. It is at this point that an insurance verification coverage process is conducted as well as pre-operative testing. <> 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. and patient education. Target Fair Price: $12,250. Weight loss surgery is an effective treatment for morbid obesity. The information you provide will enable us to assist you as efficiently as possible. BMI 35 - 39.9 AND one of the following. *GP( @ r UQ T9 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. 789 0 obj <>stream *GP( @ r UQ T9 x]6}W6&DtX-kC[ZVK~L`EzT*Y`&n|pzs{(Ri])7)77//|}Qo^Om^pomnpSoNoU]\G.ih5 *GP( @ r UQ T9 However, an exclusion of weight loss surgery from your BCBS plan should not discourage you from exploring various low cost self-pay options. Medicaids Criteria for Weight Loss Surgery Coverage. However, coverage and payment for these services depends on the type of provider submitting the claim, the procedure/service and diagnosis codes submitted, and the patient's contract with Blue Cross. Greater than or equal to 18 years; or b. The letter should also state that the physician has evaluated the patients mental condition and he/she is fully prepared for the surgery. Skip to content. Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. Anthems full policy on weight loss surgery insurance coverage is no longer available online.
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