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 Bariatric Surgery Bariatric surgery is performed to treat morbid (clinically severe) obesity. If you have symptoms of an urgent nature, please call your doctor or go to . website at www.calpers.ca.gov. %PDF-1.6 % If a conflict arises between a CPCP and | If you are a Highmark member, please review and discuss any questions regarding medical policies with your treating provider and refer to your specific . @h23Begj!b4ZJ2}Y*bPc6d 5d 05dD/Br,Fsr#0Yi^kRsTCx aEt! Sometimes you will need to Read more *GP( @ r UQ T9 Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. 13 0 obj Diagnosis of Morbid obesity, defined as. endstream Medicaids Criteria for Weight Loss Surgery Coverage. *GP( @ r UQ T9 It is important to know that your employer can typically opt-out of weight loss surgery insurance coverage for their employees policies. Conservative measures for weight reduction should include changes to the individual's dietary, medication, and exercise regimen; The individual must complete a multidisciplinary evaluation including medical, nutritional, and psychological evaluations. Provider Discharge Form. 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. 2 0 obj *GP( @ r UQ T9 Request Out of Network Benefits. Consult and recommendation from a weight loss surgeon. *GP( @ r UQ T9 Substantially impaired quality of life or activities of daily living; Moderate to severe OSA (apnea-hypopnea index greater than 15); Individuals must 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. ALL endobj This new site may be offered by a vendor or an independent third party. endobj About Us. I have Anthem Blue Cross Blue Shield through my husband's job here in MO and they cover "medically necessary" revisions with a BMI over 40 or over 35 . Blue Cross covers services for the treatment of obesity, weight management, eating disorders, nutrition and physical activity counseling. Bariatric Journal is a leading publication for bariatric surgery guides and information. R. (,`)BAk" *GP( @ r UQ T9 *GP( @ r UQ T9 *GP( @ r UQ T9 *GP( @ r UQ T9 Facilities designated as Blue Distinction and Blue . *GP( @ r UQ T9 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. a Body Mass Index (BMI) greater than 40. *GP( @ r UQ T9 How You Get Care. *GP( @ r UQ T9 Internal Medical Policy Committee 1-20-2022 Revision with coding updates; Internal Medical Policy Committee 11-29-2022 Coding update - *GP( @ r UQ T9 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. The following are three types of weight loss procedures that are covered by BCBS Alabama. Many who have sustained their weight loss through Bariatric surgery have reported a significant improvement in their overall health and lifestyle. Anthems full policy on weight loss surgery insurance coverage is no longer available online. External link You are leaving this website/app (site). *GP( @ r UQ T9 *GP( @ r UQ T9 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. 2 0 obj 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. No. Psychological Testing Form. *GP( @ r UQ T9 This website uses cookies to improve your experience. 18. hb``` cc`aX` r0(i``ZG!'f{ Bariatric Surgery Which Procedure Is Best? In addition, some sites may require you to agree to their terms of use and privacy policy. 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); xVk@~7=nBvcBP`k2OMp}Nn%04)X?P0B3MHJZ+cHf\|&r4\1oZ) "M *GP( @ r UQ T9 Revisions are covered if there is documentation of a failure secondary to a surgical complication. Many patients who have inadequate or no insurance coverage for weight loss . Contact information for your Anthem BCBS is listed below. *GP( @ r UQ T9 Generally, any procedure that is considered experimental will not be covered. No specific information regarding the requirement of an in-network surgeon is available. 4. Returning Shopper? m4:TY=6uhKy+\W5nx` G;o\c0Va H }'H1hbX50aG@$GP0~ ALL x]6}W6&DtX-kC[ZVK~L`EzT*Y`&n|pzs{(Ri])7)77//|}Qo^Om^pomnpSoNoU]\G.ih5 Bariatric Journal is the leading bariatric surgery resource site for patients. National Average: $19,450. NOTICE: This policy contains information which is clinical in nature. Medical policies serve as one set of guidelines for determining what medical services, procedures, devices and drugs may be eligible for coverage. endobj *GP( @ r UQ T9 *GP( @ r UQ T9 *GP( @ r UQ T9 *GP( @ r UQ T9 *GP( @ r UQ T9 *GP( @ r UQ T9 *GP(:&. One option is Adobe Reader which has a built-in reader. *GP( @ r UQ T9 F(wG((|1]) Pd-&mm@!U+V]]h)z'/6;]oB=u[_J^H\nt`Q[Lo{Kxcp=s}Fe?L&`mq8,!PvokA_EP%>O[ s{jSAx 6&mWwOoZLzwd\^d^77ojxmoF=+g^iKE*f{v+o'([~lr|Xj}h.]VF74;UBQ>Bw%}|LMWo/+wzW#9+O[0*9)/}b5FA@V:Kb6!eM_O$WBwg]5@uE The following bariatric procedures may be considered medically necessary for the surgical treatment of morbid obesity when hbbd```b`` "HE`Z09D|&&_IO`" H2nb3w Z'[A$)X}L?o F_ Understanding Weight-Loss Surgery: Is it for you? *GP( @ r UQ T9 *GP( @ r UQ T9 Laparoscopic adjustable gastric banding using an FDA-approved adjustable gastric band is a second-tier procedure that shouldONLYbe performed when extenuating circumstances exist. 2022 Policy Documents. *GP( @ r UQ T9 *GP( @ r UQ T9 Opting-out typically saves the company money on their premiums. *GP( @ r UQ T9 The site may also contain non-Medicare related information. Directory ofBlue Distinction Centers and Blue Distinction Centers+ for Bariatric Surgery, Program Selection Criteria For Bariatric Surgery. *GP( @ r UQ T9 Last Review: December 2022 . %PDF-1.5 Services Provided by a Hospital or Other Facility, and Ambulance Services Blue Distinction Specialty Care . Our Philosophy; . ObesityCoverage strongly feels that morbid obesity is a disease and every insurance company should cover these life saving procedures. <>/Font<>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Does Blue Cross Blue Shield of Alabama (BCBS) cover bariatric surgery? "Our comprehensive program helps patients [] *GP( @ r UQ T9 Does Blue Cross Blue Shield of Alabama (BCBS) cover bariatric surgery? Contact 866-773-2884 for authorization regarding treatment. *GP( @ r UQ T9 *GP( @ r UQ T9 Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. 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. 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). Reimbursement will be 75% of the fee schedule . *GP( @ r UQ T9 Centers for Bariatric Surgery. Morbid obesity is defined as a body mass index (BMI) greater than 40 kg/m2 or a BMI greater than 35 kg/m2 with associated complications including, but not limited to, diabetes, hypertension, or obstructive sleep apnea. *GP( @ r UQ T9 Height: 5 feet 6 inches. 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. Most PDF readers are a free download. @Z":h4PFKF&-TMAyyRGyyRGyq5)tRZO!9YHBPV"el)5CS1`SI j)fhVP0,f!6A26`xaijA@kRsTB{3 rHV+aU1^f:(sJ#:T09I+*! xV]:}G?c;HU]zU?G\} 29gfjL}a? TJicTrXbfWllWfrZIUOzp*k}`o. endobj Bariatric Surgery in Adolescents and Children Return to Clinical Indications. 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. Morbid obesity is defined as a condition of consistent and uncontrollable weight gain that is characterized by. We'll assume you're ok with this, but you can opt-out if you wish. As a result, some centers require active participation in a formal weight reduction program that includes frequent documentation of weight, dietary regimen, and exercise. In general, 20% to 30% above "ideal" bodyweight, according to standard life insurance tables, constitutes obesity. The 2022 health plan premiums are available at the CalPERS. These centers have lower complication rates and fewer readmissions. *GP( @ r UQ T9 *GP( @ r UQ T9 3 0 obj endobj *GP( @ r UQ T9
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