*GP( @ r UQ T9 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. Wellmark Blue Cross and Blue Shield is an independent licensee of the Blue Cross and Blue Shield . bariatric surgery would be considered a component of and incidental to the primary . Posted February 24, 2015. *GP( @ r UQ T9 of the selection criteria are met. 4 0 obj A member of the Blue Distinction Centers for Bariatric Surgery; Biliopancreatic bypass with duodenal switch (or open procedure) for individuals with a BMI of 50 kg/m2 or greater; Roux-en-Y gastric bypass (RYGB) (laparoscopic or open procedure); Sleeve Gastrectomy (laparoscopic or open procedure). 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. %PDF-1.7 *GP( @ r UQ T9 They are: This list is not comprehensive. If you are considering covered cardiac procedures, cancer care, knee or hip replacement, or spine surgery . *GP( @ r UQ T9 Psychiatric Residential Treatment Request Form. *GP( @ r UQ T9 Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. This website uses cookies to improve your experience. *GP( @ r UQ T9 endstream endobj startxref 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. endobj *GP( @ r UQ T9 *GP( @ r UQ T9 18. Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically. Goal Weight: 149 lbs. *GP( @ r UQ T9 Full coverage for a weight loss surgery procedure will be provided to a patient with a Body Mass Index (BMI) over 40. Blue Distinction Centers and Blue Distinction Centers+ for Bariatric Surgery offer a full range of bariatric surgery care, including: surgical. It is at this point that an insurance verification coverage process is conducted as well as pre-operative testing. 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 %%EOF Blue Distinction Centers for Bariatric Surgery, along with the Blue Distinction . endobj Weight Loss Surgery Insurance Appeal Letter & The Appeals Process, Recovery from Gastric Sleeve What to Expect from Day 1. 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. 12 0 obj Bariatric Journal does not provide medical advice, diagnosis, nor treatment. *GP( @ r UQ T9 As a result, some centers require active participation in a formal weight reduction program that includes frequent documentation of weight, dietary regimen, and exercise. Access Your Payment Options. of the adolescent selection criteria for bariatric surgery, the procedure will be denied as not medically necessary. *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. *GP( @ r UQ T9 BCBS New York Excellus Weight Loss Surgery Kaiser Permanente Covers Weight Loss Surgery. To qualify for coverage of weight loss surgery, your policy must include coverage. The Center of Excellence should be certified by the American College of Surgeons as a level 1 bariatric surgery center. Anthem BCBS may cover weight loss surgery as long as your policy does not specifically exclude coverage. % <> Is a Second Weight Loss Surgery Covered if Gastric Banding Didnt Work? Original Effective Date: December 2015. Outpatient Facility Average: $16,150. This site complies with the HONcode standard for trustworthy health information: Verify here. Primary Care Physician's Letter. 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. ObesityCoverage strongly feels that morbid obesity is a disease and every insurance company should cover these life saving procedures. It is important to know that your employer can typically opt-out of weight loss surgery insurance coverage for their employees policies. Active Participation and Documentation of non-surgical methods of weight loss. 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. Blue Cross Michigan does not cover procedures considered investigational. If the individual does not meet 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. ALL *GP( @ r UQ T9 Repeat or Revised Bariatric Surgery A. Highmark Health Options considers revision of bariatric surgeries medically necessary to correct late complications. The Horizon Info Submission Template for Practitioners is another possible you can use to makes updates to your purveyor data in our systems. (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. 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. The information you provide will enable us to assist you as efficiently as possible. 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. %PDF-1.6 % Bariatric surgery is performed to treat morbid . Log In to the Shopping Cart, Need to Make a Payment? of the selection criteria for bariatric surgery, the procedure will be denied as not medically necessary. endobj 18 years of age (special consideration if under . Learn more about weight loss surgery at Rocky Mountain Associated Physicians www.RMAP.com (801) 268-3800. Arch Surg 2009; 144(12):1150-5. FPUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUa _AUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUU=8$ /L DG If the procedure youd like to have is not listed on the approved list, it is likely not covered. 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. *GP( @ r UQ T9 stream The 2022 health plan premiums are available at the CalPERS. Location: MO. 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. *GP( @ r UQ T9 However, since Blue Cross Michigan requires a Center of Excellence, using an in-network surgeon is recommended. 2022 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option Section 5. 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. 6/2022 . 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 InterQual criteria is used to evaluate whether a medical procedure or equipment . 0 website at www.calpers.ca.gov. PPO outpatient services do not require Pre-Service Review. outpatient follow-up. Individual outcomes may vary. Target Fair Price: $12,250. Blue Distinction Centers for Bariatric Surgery, along with the Blue Distinction Centers for Cardiac Care, Blue Distinction Centers for Knee and Hip Replacement, Blue Distinction Centers for Maternity Care, Blue Distinction Centers for Spine Surgery, Blue Distinction Centers for Substance Use Treatment and Recovery and Blue Distinction Centers for Transplants are a key part of our efforts to work with doctors and facilities to improve the overall quality, and resulting affordability of specialty care. *GP( @ r UQ T9 *GP( @ r UQ T9 Oklahoma Medicare, health insurance renewal for individuals & families, Making Your Health Insurance Work For You, Prescription Drug Changes and Pharmacy Information, Machine Readable Files for Transparency in Coverage. 2022 Bariatric Surgery Coverage Announcements Summary . ZIc$"NmZ;} AdN5N`]_c[K2~3[p'X9 YM"]0*=|. To find out which services are covered under your policy at any facility, please call the customer service phone number on the back of your Blue Cross and Blue Shield of Texas member ID card. If you have symptoms of an urgent nature, please call your doctor or go to . 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. Weight Loss Surgery Insurance Coverage Criteria, The Pouch Reset Losing Weight After Weight, These 5 Habits = Weight Loss Surgery Success. *GP( @ r UQ T9 4510 13th Ave. S. bariatric surgery. 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. *GP( @ r UQ T9 and comply with all phases of pre- and post-operative care and is committed to long-term post-operative follow-up requirements; and . *GP( @ r UQ T9 Contact information for your Anthem BCBS is listed below. So, to find out if your policy includes coverage, please talk directly to Blue Cross Michigan. *GP( @ r UQ T9 View the medical and drug authorization tables to determine when to request an authorization. *GP( @ r UQ T9 <> 4 0 obj *GP( @ r UQ T9 SKYGEN USA administers dental services for Horizon NJ Health members. If this is the case and you find a second surgery or procedure is needed, you might find that Blue Cross Blue Shield does provide coverage for a second surgery as long as you followed post-operative instructions and made lifestyle changes for success as well as turned to the bariatric surgeon and other sources for additional help. External link You are leaving this website/app (site). 9 0 obj The duration of the weight loss program should have been at least twelve consecutive months. This site complies with the HONcode standard for trustworthy health information: Verify here. Psychological Testing Form. So we are happy to report that manyAnthem BCBS policies cover weight loss surgery. *GP( @ r UQ T9 File Name: bariatric_ surgery 5/1983 . Gastric Sleeve Surgery. 789 0 obj <>stream x]6}W6&DtX-kC[ZVK~L`EzT*Y`&n|pzs{(Ri])7)77//|}Qo^Om^pomnpSoNoU]\G.ih5 *GP( @ r UQ T9 The member must meet all requirements. Weight loss surgery is an effective treatment for morbid obesity. *GP( @ r UQ T9 Northeast Georgia Medical Center (NGMC) offers a variety of surgical and nonsurgical weight-loss options and is an Anthem Blue Cross Blue Shield Blue Distinction Center for Bariatric Surgery. Blue Cross PPO, Blue Cross-Blue Shield* and Cigna PPO. *GP( @ r UQ T9 Directory ofBlue Distinction Centers and Blue Distinction Centers+ for Bariatric Surgery, Program Selection Criteria For Bariatric Surgery. sVNH~}%;@9uKG*>etc2/KNvTS=TuV1i#R| Many who have sustained their weight loss through Bariatric surgery have reported a significant improvement in their overall health and lifestyle. bluecross blueshield fed blue bariatric Guide bluecross blueshield fed blue bariatric Requirements bluecross blueshield fed blue bariatric web address bluecross blueshield fed blue bariatric valid Username & Password. *GP( @ r UQ T9 *GP( @ r UQ T9 *GP( @ r UQ T9 An Independent Licensee of the Blue Cross and Blue Shield Association. *GP( @ r UQ T9 Medicaids Criteria for Weight Loss Surgery Coverage. Bariatric procedures not meeting the criteria as indicated in this policy are considered not medically necessary. 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 A representative will contact you within one to two business days to help you schedule an appointment. Bariatric and Transplant care benefits are limited to services provided in a Blue Distinction Center (see pages 62 and 66 ). *GP( @ r UQ T9 We recommend that you only use this publication in conjunction with the current year's health premium rate schedule and EOCs. 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). ALL 2022 Policy Documents. Bariatric Surgery BCBSA Ref. 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. 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 If the individual does not meetALLof the selection criteria for bariatric surgery, the procedure will be denied as not medically necessary. 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. *GP( @ r UQ T9 QiP^0#jfc~%M/8 2E .vP[mc~9} Our Philosophy; .
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