Target Fair Price: $12,250. Attainment or near-attainment of physiologic/skeletal maturity at approximately, age 13 in girls and 15 for boys. To obtain a copy of the health premium 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. a Body Mass Index (BMI) greater than 40. 0BQp>>=5>g-9{{w[(e#(Px8. Does Blue Cross Blue Shield Cover Weight Loss Surgery? 4. <> Most PDF readers are a free download. The items below are the minimum necessary for approval of your weight loss surgery. Bariatric Surgery Which Procedure Is Best? F(PP0B/_Y#T3RF(PP0B4NOCD bp 2022 Bariatric Surgery Coverage Announcements Summary . The individual's understanding of the procedure and ability to participate and comply with life-long follow-up and the life-style changes (e.g., changes in dietary habits, and beginning an exercise program) are necessary to the success of the procedure. *GP( @ r UQ T9 The panniculus hangs below the level of the pubis (which is documented in photographs); and One of the following: . 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 Distinction Specialty Care TTY users can call 1-877-486-2048. Morbid obesity is further defined as a condition of . BMI 35 - 39.9 AND one of the following. *GP( @ r UQ T9 Blue Cross Blue Shield of Minnesota Medical Policy 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 <> *GP( @ r UQ T9 Effective May 01, 2023. Full coverage for a weight loss surgery procedure will be provided to a patient with a Body Mass Index (BMI) over 40. 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. PDF 2023 Benefit Summary Book 2003 Blue Cross Blue Shield Association Technology Evaluation Center Assessment. Read information on bariatric procedures, guides, find a surgeon and more. Blue Cross Requirements for Weight Loss Surgery Do I Need To Attend? 13 0 obj *GP( @ r UQ T9 *GP( @ r UQ T9 Anthems can be contacted at1-866-293-2892. National Average: $19,450. Blue Cross Michigan does not cover procedures considered investigational. Typically, Blue Cross Blue Shield does offer coverage if your primary procedure does not produce the expected results. ,_*:1Ch_WpK3R6UYo gD_){6^9V0ljRoZY=;~lov'xmv'}y3-{lZjUTi:hnS: ]}}_v$j&m.~.?NIcWX*}pO=-f)/QeQ7vuT'UJ_\}Sj}NU~WOT}J"^ Bariatric surgery in patients with diabetes and body mass index less than 35 kg/m 2. <> *GP( @ r UQ T9 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. . *GP( @ r UQ T9 Log In to the Shopping Cart, Need to Make a Payment? *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 . Is a Second Weight Loss Surgery Covered if Gastric Banding Didnt Work? endobj Bariatric Journal is a leading publication for bariatric surgery guides and information. Blue Distinction Centers for Bariatric Surgery, along with the Blue Distinction . Pre-Cert/Pre-Auth (In-Network) - CareFirst The following bariatric procedures may be considered medically necessary for the surgical treatment of morbid obesity whenALLof the selection criteria are met. Bariatric Surgery | Blue Cross and Blue Shield of Texas - BCBSTX 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. *GP( @ r UQ T9 endobj <> *GP( @ r UQ T9 *GP( @ r UQ T9 <> *GP( @ r UQ T9 Original Effective Date: December 2015. Forms | Providers | BlueCare Tennessee - BCBST About Us. If you have symptoms of an urgent nature, please call your doctor or go to . Arch Surg 2009; 144(12):1150-5. 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 Page 18. 8 0 obj Gastric Banding including the Lap Band and Realize Band, Duodenal Switch also known as Biliopancreatic Diversion, Any other experimental weight loss procedure, The patient continues to meet all the medical necessity criteria for bariatric surgery, and, There must be documentation that the patient was compliant with the original post-operative dietary and exercise program, and. of the selection criteria for bariatric surgery, the procedure will be denied as not medically necessary. *GP( @ r UQ T9 *GP( @ r UQ T9 xVk@~7=nBvcBP`k2OMp}Nn%04)X?P0B3MHJZ+cHf\|&r4\1oZ) "M <>/Font<>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> . 12 0 obj National Range: $11,550 - $27,325+. *GP( @ r UQ T9 No. To speak to someone directly, please call 1-773-702-1618. Member meets one of the following BMI requirements and has been at that BMI for a minimum of 2 years: o BMI over 40 o BMI . How to Avoid a Denial - Bariatric Surgery Source *GP( @ r UQ T9 A new Global Period will not apply to a procedure meeting these requirements and reported with modifier 78. PDF Bariatric Surgery - Regence Returning Shopper? 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. endstream endobj startxref 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. outpatient follow-up. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. Open and laparoscopic vertical banded Gastroplasty, Patients compliance with post-operative diet and exercise regimen. Blue Cross and Blue Shield Service Benefit Plan Surgical Procedures FBF22.05b.1 Page 3 of 5 1/1/2020 Benefits for the surgical treatment of morbid obesity, performed on an inpatient or outpatient basis, are subject to the pre-surgical requirements listed below. In order to be approved by Horizon Blue Cross Blue Shield of New Jersey for bariatric surgery in the United States, you must meet the following criteria: Be Age 18 of age or older. PDF Legend - American Society for Metabolic & Bariatric Surgery Please note that not all policies include coverage. Check here bluecross blueshield fed blue bariatric official portal step by step. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. 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. Weight loss surgery is an effective treatment for morbid obesity. *GP( @ r UQ T9 Bariatric Surgery | Blue Cross and Blue Shield of Oklahoma - BCBSOK Any bariatric surgeon that accepts Blue Cross Blue Shield of Michigan will know where the surgery has to take place. Individual outcomes may vary. In addition, some sites may require you to agree to their terms of use and privacy policy. VII. *GP( @ r UQ T9 sVNH~}%;@9uKG*>etc2/KNvTS=TuV1i#R| Torrance Bariatrics Institute | Dr. Ramin Roohipour Provider Resource Center - BCBSWNY Oklahoma Medicare, health insurance renewal for individuals & families, Making Your Health Insurance Work For You, Prescription Drug Changes and Pharmacy Information, Machine Readable Files for Transparency in Coverage. 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 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. Bariatric Journal does not provide medical advice, diagnosis, nor treatment. *GP( @ r UQ T9 an Independent Licensee of the Blue Cross and Blue Shield Association If a conflict arises between a linical Payment and oding Policy ( ^ P P _) and any plan document under which a member is entitled to Covered Services, the plan document will govern. Consult and recommendation from a weight loss surgeon. *GP( @ r UQ T9 Fargo, N.D., 58121. Log In to the Shopping Cart, Need to Make a Payment? Sometimes you will need to Read more 789 0 obj <>stream Bariatric Surgery in Adolescents and Children Return to Clinical Indications. PPO outpatient services do not require Pre-Service Review. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. 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.
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