Primary Care Physician's Letter. *GP( @ r UQ T9 The items below are the minimum necessary for approval of your weight loss surgery. *GP( @ r UQ T9 hb```JB eaX `,mLBX*fLj yZq5Ugj 0;Rjy~(^QD=ysz(p'@%ssr?~oqj-w?d>Hzg.w ^p1*9V8(#]%IyE@Bq> :::h`` l "H2I&0&Y@$P9[X@D2J "*o2Sj0R 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. 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. Weight Wise Oklahoma City: Reviews, Costs 2022, WakeMed Bariatric Surgery Delivers Promising Results To Patients: Reviews, Costs 2022, UT Health Tyler Bariatric Center: Making You Feel Better: Reviews, Costs 2022, Tufts Weight and Wellness Centre: Reviews, Costs 2022, Protein Intake after Bariatric Surgery How to Get Enough Protein, Bariatric Surgery Certifications, Credentials Explained, 10 Things Your Doctor Wont Tell You About Weight Loss Surgery. The duration of the weight loss program should have been at least twelve consecutive months. 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. 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 . SKYGEN USA administers dental services for Horizon NJ Health members. (2009) Preoperative weight loss before bariatric surgery. 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 A new Global Period will not apply to a procedure meeting these requirements and reported with modifier 78. Centers for Bariatric Surgery. endobj This will depend on the type of policy you have purchased. Sometimes you will need to Read more The Center of Excellence should also hold a certification by the American Society for Bariatric Surgery as a bariatric surgery Center of Excellence. Patients in Georgia who are insured through the State Health Benefit Plan will now have coverage for weight-loss surgery beginning in 2022. In general, 20 percent to 30 percent above 'ideal' bodyweight, according to standard life insurance tables, constitutes obesity. 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 PDF BCBSM Medicare Advantage PPO Weight Loss Surgery Enhanced Benefit x]6}W6&DtX-kC[ZVK~L`EzT*Y`&n|pzs{(Ri])7)77//|}Qo^Om^pomnpSoNoU]\G.ih5 Read information on bariatric procedures, guides, find a surgeon and more. stream 2 0 obj *GP( @ r UQ T9 ALL The following bariatric procedures are considered experimental/investigational, and therefore, non-covered because the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature. Benefits Section 5(c). *GP( @ r UQ T9 %PDF-1.6 % If the individual does not meet 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. <> xVk@~7=nBvcBP`k2OMp}Nn%04)X?P0B3MHJZ+cHf\|&r4\1oZ) "M *GP( @ r UQ T9 If you have symptoms of an urgent nature, please call your doctor or go to . Coronary artery disease. Greater than or equal to 18 years; or b. 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. *GP( @ r UQ T9 <>/Metadata 2592 0 R/ViewerPreferences 2593 0 R>> *GP( @ r UQ T9 Is a Second Weight Loss Surgery Covered if Gastric Banding Didnt Work? 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. 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 site may also contain non-Medicare related information. *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. Bariatric Surgery for Morbid Obesity. Weight Loss Surgery Insurance Coverage Criteria, The Pouch Reset Losing Weight After Weight, These 5 Habits = Weight Loss Surgery Success. comply with pre- and post-surgical requirements Note: . Bariatric and Transplant care benefits are limited to services provided in a Blue Distinction Center (see pages 62 and 66 ). Attainment or near-attainment of physiologic/skeletal maturity at approximately, age 13 in girls and 15 for boys. *GP( @ r UQ T9 All rights reserved. The best option is to call them directly and ask if your policy includes coverage for CPT Code 43775. 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. *GP( @ r UQ T9 x?. Jja(6$R?_"\ :# 'c H:9 H MfG _w Y.7 Wv 9f7 g r hr UQ T9 Anthem BCBS and revisions - Revision Weight Loss Surgery - BariatricPal Reviewed: July 2022 . Bariatric surgery may be indicated for patients 18 to 60 years of age. This is the medical billing code for gastric bypass surgery. However, an exclusion of weight loss surgery from your BCBS plan should not discourage you from exploring various low cost self-pay options. Provider Discharge Form. "Dental necessity" or "dentally necessary" means or describes a dental service that a dental care provider, exercising prudent clinical judgment, would provide to a covered person for the purpose of evaluating, diagnosing or treating a dental illness . *GP( @ r UQ T9 x The information you provide will enable us to assist you as efficiently as possible. *GP( @ r UQ T9 *GP( @ r UQ T9 endobj 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. And you will still need to find a surgeon that has privileges to perform the surgery at a accredited Center Of Excellence for Bariatric Surgery. Medical Policy Update is a monthly newsletter for the health care providers who participate in our networks and submit claims to Highmark Blue Cross Blue Shield of Western New York (Highmark BCBSWNY) using the appropriate HIPAA transactions or claim forms as required by Highmark BCBSWNY.This publication focuses only on medical policy and claims administration updates, including coding . B#UVjHJ)Uc_;(T;ZAYQ}_B4UC3{mo Bariatric Surgery Bariatric surgery is performed to treat morbid (clinically severe) obesity. post-op. BCBS of Michigan provides full coverage for bariatric procedures provided the patient meets the following requirements: The patient's age is between 18 and 60. This website uses cookies to improve your experience. One option is Adobe Reader which has a built-in reader. Starting in Fall of 2022, FEP Blue Focus members can receive a . 8 0 obj Many who have sustained their weight loss through Bariatric surgery have reported a significant improvement in their overall health and lifestyle. Most PDF readers are a free download. <> Body Mass Index (BMI) of 40 or greater OR. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. Internal Medical Policy Committee 1-20-2022 Revision with coding updates; . Effective January 01, 2023, Internal Medical Policy Committee 3-23-2023 Revision - ALL *GP( @ r UQ T9 *GP( @ r UQ T9 This new process provides a faster turnaround so your updated data is displayed go our Doctor & Hospital Finder.Getting Started with the Horizon Data Submission TemplateOur reply to your email will have #Secure# added to the head von the subject line. Blue Distinction Centers for Bariatric Surgery, along with the Blue Distinction . a Body Mass Index (BMI) greater than 40. 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. Original Effective Date: December 2015. endobj website at www.calpers.ca.gov. *GP( @ r UQ T9 FPUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUa _AUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUU=8$ /L DG Surgeon: James Stephen Scott. In general, 20% to 30% above "ideal" bodyweight, according to standard life insurance tables, constitutes obesity. Do I Need To Attend? 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. Does Blue Cross Blue Shield Cover Weight Loss Surgery? hb``` cc`aX` r0(i``ZG!'f{ Yes, weight loss surgery must be done at a. 3 0 obj If you are planning on having any of the above weight loss procedures and you meet the pre-approval requirements, you should schedule an initial meeting with your Bariatric surgeon of choice who will give you an overview of the process as he/she reviews your health history to confirm eligibility. To contact Blue Cross Blue Shield of Alabama, you can either log into their official websitehttps://www.bcbsal.org/web/index.html, use the telephone numbers on the back of your BCBSA ID card or call 1-888-267-2955 for family and individual services. Bariatric Surgery | Blue Cross and Blue Shield of Illinois - BCBSIL 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 To obtain a copy of the health premium a BMI of 35 or greater with at least 2 comorbidities. Blue Cross PPO, Blue Cross-Blue Shield* and Cigna PPO. We'll assume you're ok with this, but you can opt-out if you wish. In addition, some sites may require you to agree to their terms of use and privacy policy. A weight which is at least 100 lbs. In fact, most of the Blue Cross Blue Shield network has some sort of coverage for weight loss surgery. *GP( @ r UQ T9 PDF Bariatric Surgery - Regence bariatric surgery. Do I have to use an in-network weight loss surgeon? Blue Cross Blue Shield Association. *GP( @ r UQ T9 *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. patient education. Bariatric Surgery in Adolescents and Children Return to Clinical Indications. Most PDF readers are a free download. 6 0 obj *GP( @ r UQ T9 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 of the adolescent selection criteria for bariatric surgery, the procedure will be denied as not medically necessary. Directory ofBlue Distinction Centers and Blue Distinction Centers+ for Bariatric Surgery, Program Selection Criteria For Bariatric Surgery. Posted February 24, 2015. This is true only if youve had a previous adjustable gastric banding procedure that met all of the criteria laid out for that procedure. Accept Read More, Blue Cross Blue Shield of Michigan Requirements for Weight Loss Surgery Approval, 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. 0BQp>>=5>g-9{{w[(e#(Px8. of the selection criteria are met. Does Medicaid Cover Lap Band Surgery - MedicAidTalk.net The site may also contain non-Medicare related information. (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 G-24-054 - Highmark Torrance Bariatrics Institute | Dr. Ramin Roohipour Provider Policies, Guidelines and Manuals | Anthem.com Blue Distinction Centers for Bariatric Surgery | Blue Shield of CA ANYONE The following bariatric procedures may be considered medically necessary for the surgical treatment of morbid obesity whenALLof the selection criteria are met. Centers for Bariatric Surgery. *GP( @ r UQ T9 Blue Cross covers services for the treatment of obesity, weight management, eating disorders, nutrition and physical activity counseling. In addition, some sites may require you to agree to their terms of use and privacy policy. Typically, if you paid cash for the procedure ongoing lap band fills will not be covered by insurance. 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. 0 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. 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 If you have surgery, some private Medicare Supplement plans might cover some out-of-pocket costs not covered under Original Medicare pays, such as . However, since Blue Cross Michigan requires a Center of Excellence, using an in-network surgeon is recommended. 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. endstream stream The letter should also state that the physician has evaluated the patients mental condition and he/she is fully prepared for the surgery. Goal Weight: 149 lbs. Reimbursement will be 75% of the fee schedule . Do I Need To Attend? 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. endstream endobj 749 0 obj <. *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 . 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 2 0 obj 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. Bariatric Surgery BCBSA Ref. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means Bariatric surgery in patients with diabetes and body mass index less than 35 kg/m 2. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. endobj 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. Opting-out typically saves the company money on their premiums. Please consult professional medical advice before pursuing any treatment. Most PDF readers are a free download. Directory ofBlue Distinction Centers and Blue Distinction Centers+ for Bariatric Surgery, Program Selection Criteria For Bariatric Surgery. *GP( @ r UQ T9 How You Get Care. Services Provided by a Hospital or Other Facility, and Ambulance Services Blue Distinction Specialty Care . *GP( @ r UQ T9 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. 10 0 obj FEP Blue Focus Prior Approval List - Effective January 1, 2023 . <> @h23Begj!b4ZJ2}Y*bPc6d 5d 05dD/Br,Fsr#0Yi^kRsTCx aEt! If you are considering covered cardiac procedures, cancer care, knee or hip replacement, or spine surgery . *GP( @ r UQ T9 bariatric surgery would be considered a component of and incidental to the primary . Sitemap, Bariatric Surgery 101 Guide: Read This First. or 100% over ideal weight or a body mass index (BMI) of at least 40 or a BMI of 35 with comorbidities. *GP( @ r UQ T9 *GP( @ r UQ T9 endobj ; *GP( @ r UQ T9 2 years after the original weight loss surgery, weight loss is still less than 50% of pre-operative excess body weight and weight remains at least 30% of the patients ideal body weight, per BMI. *GP( @ r UQ T9 endstream 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 *GP( @ r UQ T9 *GP( @ r UQ T9 ZIc$"NmZ;} AdN5N`]_c[K2~3[p'X9 YM"]0*=|. Bariatric Journal is a leading publication for bariatric surgery guides and information. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. So, to find out if your policy includes coverage, please talk directly to Blue Cross Michigan. *GP( @ r UQ T9 The Horizon Info Submission Template for Practitioners is another possible you can use to makes updates to your purveyor data in our systems.
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