blue cross blue shield bariatric surgery requirements 2022 blue cross blue shield bariatric surgery requirements 2022
*GP( @ r UQ T9 Bariatric Journal is a leading publication for bariatric surgery guides and information. Yes, weight loss surgery must be done at a. *GP( @ r UQ T9 Blue Distinction Centers and Blue Distinction Centers+ for Bariatric Surgery offer a full range of bariatric surgery care, including: surgical. 6/2022 . endstream O Any bariatric surgeon that accepts Blue Cross Blue Shield of Michigan will know where the surgery has to take place. Gastric Sleeve Surgery. <> and comply with all phases of pre- and post-operative care and is committed to long-term post-operative follow-up requirements; and . Bariatric Surgery Bariatric surgery is performed to treat morbid (clinically severe) obesity. 2. *GP( @ r UQ T9 During the Realize Band procedure, two devices are implanted during surgery, and the surgeon injects saline into the port to tighten or loosen the band based on weight loss goal and physical reactions to the operation. 0BQp>>=5>g-9{{w[(e#(Px8. *GP( @ r UQ T9 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. Policy: 7.01.47 Effective Date: Nov. 1, 2022 Last Revised: Jan. 1, 2023 Replaces: 7.01.47 RELATED MEDICAL POLICIES: 2.01.38 Transesophageal Endoscopic Therapies for Gastroesophageal Reflux Disease 7.01.522 Gastric Electrical Stimulation . aDonHg$z3C:?7$SCKbcT1,Q,b4Ypm15Z;x1Fa1Aha&PF+w:#7a8s /[F?&a18+Ah^Pf%&TundvhihFm{6TmO{7.[wNQyg )w ;Er'(P$x=E'(P$z}E'(eaE*;*E#lPP0Bv#G((`7BA bariatric surgery. ALL Surgery Date: 03/24/2015. A new Global Period will not apply to a procedure meeting these requirements and reported with modifier 78. 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 . 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. To view this file, you may need to install a PDF reader program. =-]U6>(-Is[i5}{u?B}X* Bariatric Journal does not provide medical advice, diagnosis, nor treatment. (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. For high BMI individuals in whom the duodenal switch may be difficult, it is reasonable to do a sleeve gastrectomy as the first stage of an intended two-stage duodenal switch. PDF 2022 Health Benefit Summary - CalPERS *GP( @ r UQ T9 2022 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option Section 5. 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). If you are a Highmark member, please review and discuss any questions regarding medical policies with your treating provider and refer to your specific . Bariatric surgery, falls into two general categories: 1) gastric-restrictive procedures that create a small gastric Does Bcbs Cover Bariatric Surgery - SurgeryTalk.net 16 0 obj 789 0 obj <>stream Blue Cross Blue Shield Of Michigan Pre-Approval Requirements. *GP( @ r UQ T9 2003 Blue Cross Blue Shield Association Technology Evaluation Center Assessment. Blue Cross and Blue Shield is an association of . To qualify for coverage of weight loss surgery, your policy must include coverage. Learn about BCBS of Alabama's requirements for weight-loss surgery. 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). Referral for Applied Behavioral Analysis (ABA) Assessment, Initiation and Continuation Request Form for Applied Behavior Analysis. *GP( @ r UQ T9 *GP( @ r UQ T9 Miscellaneous Bariatric Procedures - Wellmark *GP( @ r UQ T9 . endobj *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. BMI 35 - 39.9 AND one of the following. 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. 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. Surgeon: James Stephen Scott. of the selection criteria are met. Policies, Guidelines & Manuals. This Program aligns with the Metabolic and Bariatric Surgery Accreditation and Quality Improvement *GP( @ r UQ T9 Posted February 24, 2015. 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 Morbid It is at this point that an insurance verification coverage process is conducted as well as pre-operative testing. Medical Policy #: 02.01.56 . VII. Bariatric Surgery for Obesity - UChicago Medicine *GP( @ r UQ T9 We removed the limit on covered non-sibling donors for transplant services . *GP( @ r UQ T9 Bariatric Surgery BCBSA Ref. Blue Distinction Centers for Bariatric Surgery, along with the Blue Distinction . Bariatric and Transplant care benefits are limited to services provided in a Blue Distinction Center (see pages 62 and 66 ). Full coverage for a weight loss surgery procedure will be provided to a patient with a Body Mass Index (BMI) over 40. F(wG((|1]) The Center of Excellence should be certified by the American College of Surgeons as a level 1 bariatric surgery center. *GP( @ r UQ T9 %PDF-1.5 Starting in Fall of 2022, FEP Blue Focus members can receive a . Surgery: Gastric Bypass. Effective January 01, 2023, Internal Medical Policy Committee 3-23-2023 Revision - 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 BCBS New York Excellus Weight Loss Surgery Kaiser Permanente Covers Weight Loss Surgery. 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 *GP( @ r UQ T9 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. *GP( @ r UQ T9 Blue Distinction. If the individual does not meetALLof the selection criteria for bariatric surgery, the procedure will be denied as not medically necessary. Contact information for your Anthem BCBS is listed below. *GP( @ r UQ T9 Individual outcomes may vary. stream Here you will find information for assessing coverage options, guidelines for clinical utilization management, practice policies, the provider manual and support for delivering benefits to our members. a BMI of 35 or greater with at least 2 comorbidities. Bariatric surgery (any procedure) for patients with a BMI < 35 kg/m 2 including but not limited to solely as a cure for type 2 diabetes mellitus; . Blue Cross covers services for the treatment of obesity, weight management, eating disorders, nutrition and physical activity counseling. If your policy covers gastric bypass then it should cover other bariatric surgery procedures as well. 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. 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). *GP( @ r UQ T9 External link You are leaving this website/app (site). Psychological Testing Form. hbbd```b``~"gHR ,,"G3`q+0%XW8gC3kIG vD2u 6 Hf`bd`20R x g 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. <> hbbd```b`` "HE`Z09D|&&_IO`" H2nb3w Z'[A$)X}L?o F_ hb```JB eaX `,mLBX*fLj yZq5Ugj 0;Rjy~(^QD=ysz(p'@%ssr?~oqj-w?d>Hzg.w ^p1*9V8(#]%IyE@Bq> :::h`` l "H2I&0&Y@$P9[X@D2J "*o2Sj0R 9 0 obj Active Participation and Documentation of non-surgical methods of weight loss. This site complies with the HONcode standard for trustworthy health information: Verify here. 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. Outpatient Facility Average: $16,150. As a result, some centers require active participation in a formal weight reduction program that includes frequent documentation of weight, dietary regimen, and exercise. Learn about BCBS of Alabamas requirements for weight-loss surgery. . *GP( @ r UQ T9 FPUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUa _AUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUU=8$ /L DG 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. Target Fair Price: $12,250. Greater than or equal to 18 years; or b. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. 12 0 obj Forms | Providers | BlueCare Tennessee - BCBST 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. 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. Opting-out typically saves the company money on their premiums. What is a Weight Loss Seminar? 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. Bariatric Surgery for Morbid Obesity. 4 0 obj Reimbursement will be 75% of the fee schedule . 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. Origination: Last Review: Description of Procedure or Service . According to Blue Cross/Blue Shield of California Medically Necessary. If you are considering covered cardiac procedures, cancer care, knee or hip replacement, or spine surgery . 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. 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. $150. outpatient follow-up. of the following criteria: If the adolescent does not meet The duration of the weight loss program should have been at least twelve consecutive months. PDF CLINICAL MEDICAL POLICY - Highmark Health Options Take our bariatric surgery test! For more information, please contact SKYGEN USA 1-855-878-5368. Height: 5 feet 6 inches. Please contact BCBS of Michigan directly to find out if they offer coverage for a second procedure. Effective May 01, 2023. <>>> *GP( @ r UQ T9 *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. <> 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. *GP( @ r UQ T9 Will Your Stomach Stretch after Gastric Sleeve Surgery? 3 0 obj Rohit A Patel, MD, FACS, FASMBS | Cooper University Health Care In fact, most of the Blue Cross Blue Shield network has some sort of coverage for weight loss surgery. Individual outcomes may vary. 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. An Independent Licensee of the Blue Cross and Blue Shield Association. 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. 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 Oklahoma member ID card. *GP( @ r UQ T9 How to Avoid a Denial - Bariatric Surgery Source 4 0 obj Log In to the Shopping Cart, Need to Make a Payment? The site may also contain non-Medicare related information. *GP( @ r UQ T9 Anthems full policy on weight loss surgery insurance coverage is no longer available online. *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. x]6}W6&DtX-kC[ZVK~L`EzT*Y`&n|pzs{(Ri])7)77//|}Qo^Om^pomnpSoNoU]\G.ih5 Log In to the Shopping Cart, Need to Make a Payment? Torrance Bariatrics Institute | Dr. Ramin Roohipour No specific information regarding the requirement of an in-network surgeon is available. stream Conversion or revision surgery is considered not medically necessary when due to inadequate weight loss related to non-compliance with post-operative nutrition and exercise recommendations. 5 0 obj *GP( @ r UQ T9 No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means All rights reserved. Section 3. *GP( @ r UQ T9 These include but are not limited to: 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); *GP( @ r UQ T9 Register for MyBlue. These centers have lower complication rates and fewer readmissions. accredited by the metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Blue Distinction Specialty Care Open Gastric Bypass Surgery This procedure is rare and only performed under particular medical circumstances. This is the medical billing code for gastric bypass surgery. BCBS of Alabama Bariatric Surgery: Requirements, Options, Cost, Denails PDF Medical Management of Obstructive Sleep Apnea Syndrome - Blue Cross and The information you provide will enable us to assist you as efficiently as possible. 2 0 obj endobj 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. Revisions are covered if there is documentation of a failure secondary to a surgical complication. PDF Reimbursement Information - BCBSIL *GP( @ r UQ T9 Bariatric procedures not meeting the criteria as indicated in this policy are considered not medically necessary. vomiting, esophageal spasm); Band slippage and/or prolapse that cannot be corrected with manipulation or adjustment; Stricture/stenosis with dysphagia, solid food intolerance and/or severe reflux; Non-absorption resulting in hypocalcemia or malnutrition; Weight loss of 20 percent or more below ideal body weight. there are documented recurrent or chronic rashes, infections, cellulitis, or non-healing ulcers, that do . 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 4. Blue Cross Blue Shield of North Carolina NC 3,700,000 4/1/2021 link X X X Anthem Blue Cross Blue Shield GA 3,600,000 8/13/2020 link X X CareFirst Blue Cross Blue Shield DC, MD, northern VA 3,500,000 7/1/2020 link X X (6 consecutive months w/in past 2 years) Anthem Blue Cross Blue Shield OH 3,400,000 8/13/2020 link X X Horizon Data Submission Template - Horizon Blue Cross Blue Shield of To obtain a copy of the health premium *GP( @ r UQ T9 Weight loss surgery is an effective treatment for morbid obesity. endstream endobj 749 0 obj <. endobj Request Out of Network Benefits. Laparoscopic adjustable gastric banding is contraindicated for individuals aged 17 years or under. Panniculectomy is considered medically necessary for the individual who meets the following criteria: . <> 0 Any bariatric surgeon that accepts Blue Cross Blue Shield of Michigan will know where the surgery has to take place. Most PDF readers are a free download. *GP( @ r UQ T9 Individual outcomes may vary. 18 years of age (special consideration if under 18 with severe morbid obesity and special circumstances). No. 2 0 obj *GP( @ r UQ T9 *GP( @ r UQ T9 endstream endobj startxref Copyright 2022 Bariatric Journal, All Rights Reserved. R. (,`)BAk" *GP( @ r UQ T9 *GP( @ r UQ T9 The patient meets one of the following age requirements: a. *GP( @ r UQ T9 *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. hb``` cc`aX` r0(i``ZG!'f{ A weight which is at least 100 lbs. <>/Metadata 2592 0 R/ViewerPreferences 2593 0 R>> *GP( @ r UQ T9 Bariatric Surgery | Blue Cross and Blue Shield of Illinois - BCBSIL
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