blue cross blue shield bariatric surgery requirements 2022florida man september 25, 2001
G-24-054 - Highmark 13 0 obj <> Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. Will Insurance Cover My Plastic Surgery After Massive - ObesityHelp For more information, please contact SKYGEN USA 1-855-878-5368. PDF Bariatric Surgery - Regence Skip to content. *GP( @ r UQ T9 *GP( @ r UQ T9 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 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 . "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 *GP( @ r UQ T9 They are: This list is not comprehensive. Log In to the Shopping Cart, Need to Make a Payment? 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). website at www.calpers.ca.gov. The individual's medical record documentation should indicate that all psychosocial issues have been identified and addressed; The individual must be able to show decisional capacity and maturity in the psychological evaluation and provide informed assent for surgical management; The individual must be capable and willing to adhere to nutritional guidelines postoperatively; The individual must have a supportive and committed family environment; Selection criteria is a critical process requiring psychiatric evaluation and a multidisciplinary team approach. Revisions to the surgery are covered by Blue Cross Michigan. Does Medicaid Cover Lap Band Surgery - MedicAidTalk.net <> Review: Prosper Healthcare Lending Should You Choose it for Bariatric Surgery Financing? *GP( @ r UQ T9 QiP^0#jfc~%M/8 2E .vP[mc~9} 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 A weight which is at least 100 lbs. PDF Bariatric Surgery Selection Criteria - Blue Cross Blue Shield Association Do Blue Cross & Blue Shield Cover Gastric Sleeve? Liq V8 K+%w\R,XXXYY&1]yxh~C%k.2 MeOaLd9 sG@Afd`}w U 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. 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. *GP( @ r UQ T9 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. hbbd```b`` "HE`Z09D|&&_IO`" H2nb3w Z'[A$)X}L?o F_ Effective May 01, 2023. Do I Need To Attend? endobj *GP( @ r UQ T9 *GP( @ r UQ T9 aDonHg$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 *GP( @ r UQ T9 Bariatric Surgery in Adolescents and Children Return to Clinical Indications. endobj Understanding Weight-Loss Surgery: Is it for you? 6Nale{Aq;7Qy=1(tg?fd``{ X'@``} QT` Bariatric Surgery | Blue Cross and Blue Shield of Texas - BCBSTX 6 0 obj Any bariatric surgeon that accepts Blue Cross Blue Shield of Michigan will know where the surgery has to take place. Does Blue Cross Blue Shield of Alabama (BCBS) cover bariatric surgery? 15 0 obj endobj *GP( @ r UQ T9 6 0 obj Medicaids Criteria for Weight Loss Surgery Coverage. The eligible bariatric surgical procedures listed above unless otherwise specified are covered for individuals under the age of 18 years when they meetALLof the following criteria: If the adolescent does not meetALLof the adolescent selection criteria for bariatric surgery, the procedure will be denied as not medically necessary. *GP( @ r UQ T9 *GP( @ r UQ T9 Sometimes you will need to Read more endobj *GP( @ r UQ T9 endobj 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. Returning Shopper? (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. <> Blue Cross covers services for the treatment of obesity, weight management, eating disorders, nutrition and physical activity counseling. *GP( @ r UQ T9 PDF Bariatric Surgery Selection Criteria - Blue Cross Blue Shield Association 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. Weight Loss Surgery and the Insurance Process *GP( @ r UQ T9 These centers have lower complication rates and fewer readmissions. *GP( @ r UQ T9 Surgery: Gastric Bypass. *GP( @ r UQ T9 External link You are leaving this website/app (site). Register for MyBlue. File Name: bariatric_ surgery 5/1983 . n+b%M@9A9 @@uP3\` 44L3vt M, D0u`BYEH28s1bi30cs7 *&1g The items below are the minimum necessary for approval of your weight loss surgery. This website uses cookies to improve your experience. there are documented recurrent or chronic rashes, infections, cellulitis, or non-healing ulcers, that do . 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 . Surgeon: James Stephen Scott. Medical Policies A-Z. *GP( @ r UQ T9 QHP Small Group Actual Policy Documents; . *GP( @ r UQ T9 Bariatric Surgery BCBSA Ref. External link You are leaving this website/app (site). 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. These may include: The weight loss surgery should have been prescribed by a physician other than the operating surgeon. Provider Policies, Guidelines and Manuals | Anthem.com Procedures . Target Fair Price: $12,250. vomiting, esophageal spasm); Band slippage and/or prolapse that cannot be corrected with manipulation or adjustment; Stricture/stenosis with dysphagia, solid food intolerance and/or severe reflux; Non-absorption resulting in hypocalcemia or malnutrition; Weight loss of 20 percent or more below ideal body weight. Blue Cross of California is the trade name for Anthem BCBS so your criteria for weight loss surgery will be the same as it is here. GQ^3>EtB0Pq*%`4)}S[]6 Va.sMnLdEcobqV}un s^-(w=f(o`?~~qC 7KPDBBERo>(^Bg,{8uWU tASR/a^_NX,vfUrOG(!YW_^H Contact 866-773-2884 for authorization regarding treatment. Medical Policy #: 02.01.56 . *GP(:&. x stream 1 0 obj Pd-&mm@!U+V]]h)z'/6;]oB=u[_J^H\nt`Q[Lo{Kxcp=s}Fe?L&`mq8,!PvokA_EP%>O[ s{jSAx 6&mWwOoZLzwd\^d^77ojxmoF=+g^iKE*f{v+o'([~lr|Xj}h.]VF74;UBQ>Bw%}|LMWo/+wzW#9+O[0*9)/}b5FA@V:Kb6!eM_O$WBwg]5@uE stream *GP( @ r UQ T9 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. BCBS of Alabama Bariatric Surgery: Requirements, Options, Cost, Denails Last Review: December 2022 . The following bariatric procedures may be considered medically necessary for the surgical treatment of morbid obesity when The 2022 health plan premiums are available at the CalPERS. In general, 20% to 30% above "ideal" bodyweight, according to standard life insurance tables, constitutes obesity. *GP( @ r UQ T9 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 . 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. Revised: July 2022. The site may also contain non-Medicare related information. Returning Shopper? endobj 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.
