*GP( @ r UQ T9 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. Wellmark Blue Cross and Blue Shield is an independent licensee of the Blue Cross and Blue Shield . Blue Distinction. October 2017. 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! ;.SovgPmc0u Ut9p+o1)ddT,c2MXy`PO;V kFXn^n1=u C5UL|efWaXenAFKua{ %,U(>t~;xL*[lMfl/$"Rg: >ArMT+&9!-Aa(=Xj _i5j)tpJh$D':uZ;yz.1KLLF 2. Procedures . 2 0 obj 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. All rights reserved. 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 . However, an exclusion of weight loss surgery from your BCBS plan should not discourage you from exploring various low cost self-pay options. Opting-out typically saves the company money on their premiums. endobj External link You are leaving this website/app (site). 13 0 obj QHP Small Group Actual Policy Documents; . *GP( @ r UQ T9 Blue Cross covers services for the treatment of obesity, weight management, eating disorders, nutrition and physical activity counseling. Revisions are covered if there is documentation of a failure secondary to a surgical complication. 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. 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. 4 0 obj 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. Skilled Nursing Facility and Inpatient Rehabilitation Fax Form. 2022 Bariatric Surgery - BCBSRI "Our comprehensive program helps patients [] 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. This new site may be offered by a vendor or an independent third party. 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. Yes, some Blue Cross Blue Shield plans may not cover bariatric surgery. Bariatric surgery, falls into two general categories: 1) gastric-restrictive procedures that create a small gastric 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. endobj Please contact BCBS of Michigan directly to find out if they offer coverage for a second procedure. Blue Cross Blue Shield of Minnesota Medical Policy 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 Bariatric surgery may be indicated for patients 18 to 60 years of age. No specific information regarding the requirement of an in-network surgeon is available. 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. NOTICE: This policy contains information which is clinical in nature. One option is Adobe Reader which has a built-in reader. FEP Blue Focus Prior Approval List - Effective January 1, 2023 . *GP( @ r UQ T9 endstream Facilities designated as Blue Distinction and Blue . Surgical repair to correct perioperative or late chronic complications of a bariatric procedure may be considered medically necessary when there is documentation of a surgical complication related to the perioperative or late chronic complications of a bariatric procedure. Location: MO. *GP( @ r UQ T9 The site may also contain non-Medicare related information. endobj Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. The following bariatric procedures may be considered medically necessary for the surgical treatment of morbid obesity whenALLof the selection criteria are met. Last Review: December 2022 . ,_*:1Ch_WpK3R6UYo gD_){6^9V0ljRoZY=;~lov'xmv'}y3-{lZjUTi:hnS: ]}}_v$j&m.~.?NIcWX*}pO=-f)/QeQ7vuT'UJ_\}Sj}NU~WOT}J"^ Medical policies for providers | Wellmark Directory ofBlue Distinction Centers and Blue Distinction Centers+ for Bariatric Surgery, Program Selection Criteria For Bariatric Surgery. *GP( @ r UQ T9 *GP( @ r UQ T9 Log In to the Shopping Cart, Need to Make a Payment? Provider Resource Center - BCBSWNY Medicaids Criteria for Weight Loss Surgery Coverage. *GP( @ r UQ T9 post-op. 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. 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. of the selection criteria are met. Medical Policies A-Z. File Name: bariatric_ surgery 5/1983 . %PDF-1.5 <> Weight Loss Surgery and the Insurance Process 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. Learn about BCBS of Alabama's requirements for weight-loss surgery. Any bariatric surgeon that accepts Blue Cross Blue Shield of Michigan will know where the surgery has to take place. Bariatric Surgery | Blue Cross and Blue Shield of Texas - BCBSTX This site complies with the HONcode standard for trustworthy health information: Verify here. *GP( @ r UQ T9 endobj Gastric banding, Lap Banding and Realize Band Gastric banding involve fitting an adjustable silicone band around the upper part of the stomach where the band restricts the amount of food and caloric intake, consequently allowing patients to lose up to 45% of their weight. 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. *GP( @ r UQ T9 This website uses cookies to improve your experience. 1 0 obj *GP( @ r UQ T9 *GP( @ r UQ T9 Homepage Arash Sh 2022-11-18T01:32:57-08:00. . 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 Surgical procedures following a previous weight loss surgery that did not result adequate weight loss, such as a lap band or realize band to a gastric bypass, gastric sleeve or duodenal switch are covered by insurance when the following criteria are met: Does Anthem BCBS Require Center Of Excellence? 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 Laparoscopic adjustable gastric banding is contraindicated for individuals aged 17 years or under. 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. BMI 35 - 39.9 AND one of the following. Body Mass Index (BMI) of 40 or greater OR. PDF 2023 Benefit Summary Book 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. G-24-054 - Highmark Returning Shopper? 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. 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. 2022 Policy Documents. *GP( @ r UQ T9 Below, you'll learn what factors into the cost of . *GP( @ r UQ T9 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 *GP( @ r UQ T9 Page 18. 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. *GP( @ r UQ T9 6 0 obj x InterQual criteria is used to evaluate whether a medical procedure or equipment . *GP( @ r UQ T9 BCBS of Alabama Bariatric Surgery: Requirements, Options, Cost, Denails
Orlando Donation Request,
The Ark Animal Welfare Trust Farnborough,
Articles B