A psychological evaluation must be performed by a licensed mental health care professional, and the individual must be recommended for bariatric surgery. *GP( @ r UQ T9 ALL 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. Copyright 2022 Bariatric Journal, All Rights Reserved. 15 0 obj *GP( @ r UQ T9 *GP( @ r UQ T9 Morbid 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 . However, since Blue Cross Michigan requires a Center of Excellence, using an in-network surgeon is recommended. Individual outcomes may vary. GQ^3>EtB0Pq*%`4)}S[]6 Va.sMnLdEcobqV}un s^-(w=f(o`?~~qC 7KPDBBERo>(^Bg,{8uWU tASR/a^_NX,vfUrOG(!YW_^H PPO outpatient services do not require Pre-Service Review. *GP( @ r UQ T9 Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. <> Weight loss surgery is an effective treatment for morbid obesity. *GP( @ r UQ T9 *GP( @ r UQ T9 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. endobj Access Your Payment Options. or 100% over ideal weight or a body mass index (BMI) of at least 40 or a BMI of 35 with comorbidities. 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). 6 0 obj ; The duration of the weight loss program should have been at least twelve consecutive months. Typically, Blue Cross Blue Shield does offer coverage if your primary procedure does not produce the expected results. 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. As a result, some centers require active participation in a formal weight reduction program that includes frequent documentation of weight, dietary regimen, and exercise. *GP( @ r UQ T9 *GP( @ r UQ T9 This also applies to the Blue Care Network of Michigan. The Horizon Info Submission Template for Practitioners is another possible you can use to makes updates to your purveyor data in our systems. This policy version was replaced October 31, 2022. . *GP( @ r UQ T9 About Us. Consult and recommendation from a weight loss surgeon. *GP( @ r UQ T9 The following bariatric procedures may be considered medically necessary for the surgical treatment of morbid obesity when Effective January 01, 2023, Internal Medical Policy Committee 3-23-2023 Revision - 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. 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 Origination: Last Review: Description of Procedure or Service . Does Blue Cross Blue Shield of Alabama (BCBS) cover bariatric surgery? Internal Medical Policy Committee 1-20-2022 Revision with coding updates; . 3 0 obj when Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. 4 0 obj Body Mass Index (BMI) of 40 or greater OR. <> 2. or 100% over ideal weight; Medically refractory hypertension (blood pressure greater than 140 mmHg systolic and/or 90 mmHg diastolic despite concurrent use of three (3) anti-hypertensive agents of different classes); Cardiovascular heart disease (with objective documentation by exercise stress test, radionuclide stress test, pharmacologic stress test, stress echocardiography, CT angiography, coronary angiography, heart failure or prior myocardial infarction); Coronary heart disease (with objective documentation (by exercise stress test, radionuclide stress test, pharmacologic stress test, stress echocardiography, heart failure, or prior myocardial infarction); Hyperlipidemia (above 30mg/dl above guideline-directed goal) on maximum doses of monotherapy; Diabetes mellitus type II; with glycosylated hemoglobin (HbA1C) above 8.0 percent on one (1) or more medications; Obstructive sleep apnea (OSA); (diagnosed by polysomnography showing apnea-hypopnea index of 15 events per hour or more); Pickwickian syndrome (a combination of OSA and OHS); Nonalcoholic fatty liver disease (NAFLD); The individual must have documented failure to respond to conservative measures for weight reduction for a period of at least six (6) consecutive months, prior to consideration of bariatric surgery, and these attempts should be reviewed by the practitioner prior to seeking approval for the surgical procedure. All rights reserved. 1 0 obj outpatient follow-up. 1202 0 obj <> endobj *GP( @ r UQ T9 Many who have sustained their weight loss through Bariatric surgery have reported a significant improvement in their overall health and lifestyle. *GP( @ r UQ T9 %PDF-1.6 % Benefits Section 5(c). Directory of Blue Distinction Centers and . 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 BMI 35 - 39.9 AND one of the following. External link You are leaving this website/app (site). Patients in Georgia who are insured through the State Health Benefit Plan will now have coverage for weight-loss surgery beginning in 2022. Policies, Guidelines & Manuals. Section 3. *GP( @ r UQ T9 So, to find out if your policy includes coverage, please talk directly to Blue Cross Michigan. 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 *GP( @ r UQ T9 2022 Blue Cross and Blue Shield of Louisiana Blue Cross and Blue Shield of Louisiana is an independent licensee of the Blue Cross and Blue Shield Association and incorporated as Louisiana Health Service & Indemnity Company. *GP( @ r UQ T9 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 . Reimbursement will be 75% of the fee schedule . Arch Surg 2009; 144(12):1150-5. *GP( @ r UQ T9 We removed the limit on covered non-sibling donors for transplant services . *GP( @ r UQ T9 <>>> QHP Small Group Actual Policy Documents; . So we are happy to report that manyAnthem BCBS policies cover weight loss surgery. Bariatric surgery may be indicated for patients 18 to 60 years of age. 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 As a result, some centers require active participation in a formal weight reduction program that includes frequent documentation of weight, dietary regimen, and exercise. If you are considering covered cardiac procedures, cancer care, knee or hip replacement, or spine surgery . The individual 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. of the adolescent selection criteria for bariatric surgery, the procedure will be denied as not medically necessary. 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 If a conflict arises between a CPCP and *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. To obtain a copy of the health premium *GP( @ r UQ T9 Gastric Sleeve Surgery. 2022 Policy Documents. ZIc$"NmZ;} AdN5N`]_c[K2~3[p'X9 YM"]0*=|. endobj Height: 5 feet 6 inches. Returning Shopper? The site may also contain non-Medicare related information. *GP( @ r UQ T9 Access Your Payment Options. %PDF-1.7 *GP( @ r UQ T9 This will depend on the type of policy you have purchased. Bariatric Surgery in Adolescents and Children Return to Clinical Indications. Less than 18 years of age and has attained Tanner 4 or 5 pubertal . Blue Cross PPO, Blue Cross-Blue Shield* and Cigna PPO. This site complies with the HONcode standard for trustworthy health information: Verify here. *GP( @ r UQ T9 14 0 obj Most PDF readers are a free download. If you have Original Medicare, Part A and Part B, you can call Medicare at 1-800-MEDICARE . Blue Distinction Centers for Bariatric Surgery, along with the Blue Distinction . Based on our data, the target fair price for a laparoscopic hysterectomy is $12,250, whether you have health insurance or not. *GP( @ r UQ T9 and As a result, some centers require active participation in a formal weight reduction program that includes frequent documentation of weight, dietary regimen, and exercise. How You Get Care. Last Review: December 2022 . Does Blue Cross Blue Shield of Alabama (BCBS) cover bariatric surgery? and patient education. Weight Loss Surgery Insurance Appeal Letter & The Appeals Process, Recovery from Gastric Sleeve What to Expect from Day 1. Returning Shopper? This new site may be offered by a vendor or an independent third party. The individual is morbidly obese and is at least 18 years of age. *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. *GP(:&. Bariatric Journal is a leading publication for bariatric surgery guides and information. Revised: July 2022. BCBS New York Excellus Weight Loss Surgery Kaiser Permanente Covers Weight Loss Surgery. 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. Blue Cross Blue Shield Of Michigan Pre-Approval Requirements. Reviewed: July 2022 . <>/Metadata 2592 0 R/ViewerPreferences 2593 0 R>> sVNH~}%;@9uKG*>etc2/KNvTS=TuV1i#R| %%EOF Yes, weight loss surgery must be done at a. Repeat or Revised Bariatric Surgical Procedures. One option is Adobe Reader which has a built-in reader. <> $150. <> *GP( @ r UQ T9 ANYONE stream Revisions are covered if there is documentation of a failure secondary to a surgical complication. % 1 0 obj Coronary artery disease. 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. Blue Cross Michigan does not cover procedures considered investigational. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. 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 . 748 0 obj <> endobj It is important to know that your employer can typically opt-out of weight loss surgery insurance coverage for their employees policies. rvYWDgg!MxV *GP( @ r UQ T9 To speak to someone directly, please call 1-773-702-1618. This is the medical billing code for gastric bypass surgery. 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. *GP( @ r UQ T9 These centers have lower complication rates and fewer readmissions. *GP( @ r UQ T9 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. *GP( @ r UQ T9 We are on a mission to help educate millions the benefits of weight loss surgery. 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 comply with pre- and post-surgical requirements Note: . 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 . No specific information regarding the requirement of an in-network surgeon is available. Repeat surgical procedures for revision or conversion to another surgical procedure may be considered medically necessary when the initial bariatric surgery was medically necessary (and the individual continues to meet all the medical necessity criteria for bariatric surgery);andwhenANYONEof the following criteria is met: Internal Medical Policy Committee 11-29-2022 Coding update - December 06, 2022, Fargo (Headquarters) 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. Please consult professional medical advice before pursuing any treatment. If the individual does not meet *GP( @ r UQ T9 %PDF-1.6 % endstream F(wG((|1]) *GP( @ r UQ T9 To view this file, you may need to install a PDF reader program. Posted February 24, 2015. endobj 2019 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus. stream If the procedure youd like to have is not listed on the approved list, it is likely not covered. <>/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>> Unsure which surgery is right for you? *GP( @ r UQ T9 MyBlue offers online tools, resources and services for Blue Cross Blue Shield of Arizona Members, contracted brokers/consultants, healthcare professionals, and group benefit administrators. *GP( @ r UQ T9 This site complies with the HONcode standard for trustworthy health information: Verify here. a BMI of 35 or greater with at least 2 comorbidities. 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. Location: MO. @h23Begj!b4ZJ2}Y*bPc6d 5d 05dD/Br,Fsr#0Yi^kRsTCx aEt! *GP( @ r UQ T9 *GP( @ r UQ T9 Inpatient Facility Average: $25,925. Weight Loss Surgery Insurance Coverage Criteria, The Pouch Reset Losing Weight After Weight, These 5 Habits = Weight Loss Surgery Success. orlando health team member connect, knollwood club, lake forest membership fees,
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