*GP( @ r UQ T9 Yes, weight loss surgery must be done at a. To obtain a copy of the health premium 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. stream
*GP( @ r UQ T9 Medical Policy #: 02.01.56 . 1226 0 obj
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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% 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. 2022 Bariatric Surgery Coverage Announcements Summary . Access Your Payment Options. *GP( @ r UQ T9 Blue Distinction Criteria. Typically, Blue Cross Blue Shield does offer coverage if your primary procedure does not produce the expected results. or 100 percent over ideal weight or a body mass index (BMI) of at least 40 or a BMI of 35 with comorbidities. The site may also contain non-Medicare related information. <>
External link You are leaving this website/app (site). *GP( @ r UQ T9 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. Information regarding coverage of a second weight loss surgery is not available. *GP( @ r UQ T9 *GP( @ r UQ T9 *GP( @ r UQ T9 xV]:}G?c;HU]zU?G\} 29gfjL}a?
TJicTrXbfWllWfrZIUOzp*k}`o. File Name: bariatric_ surgery 5/1983 . This website uses cookies to improve your experience. *GP( @ r UQ T9 Understanding Weight-Loss Surgery: Is it for you? Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. Access Your Payment Options. 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. 2. Skip to content. This new site may be offered by a vendor or an independent third party. x Do I Need To Attend? x]6}W6&DtX-kC[ZVK~L`EzT*Y`&n|pzs{(Ri])7)77//|}Qo^Om^pomnpSoNoU]\G.ih5 Blue Cross covers services for the treatment of obesity, weight management, eating disorders, nutrition and physical activity counseling. <>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 960 540] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>>
This site complies with the HONcode standard for trustworthy health information: Verify here. Revised: July 2022. *GP( @ r UQ T9 Blue Distinction Centers and Blue Distinction Centers+ for Bariatric Surgery offer a full range of bariatric surgery care, including: surgical. Contact information for your Anthem BCBS is listed below. *GP( @ r UQ T9 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. Centers for Bariatric Surgery. endobj
*GP( @ r UQ T9 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. hbbd```b`` "HE`Z09D|&&_IO`" H2nb3w Z'[A$)X}L?o F_
These centers have lower complication rates and fewer readmissions. *GP( @ r UQ T9 Surgery: Gastric Bypass. 9 0 obj
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. Less than 18 years of age and has attained Tanner 4 or 5 pubertal . *GP( @ r UQ T9 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 6Nale{Aq;7Qy=1(tg?fd``{ X'@``} QT`
2019 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus. Laparoscopic adjustable gastric banding using an FDA-approved adjustable gastric band is a second-tier procedure that shouldONLYbe performed when extenuating circumstances exist. Renew Illinois Individual, Family & Medicaid Health Insurance, Blue Cross Community MMAI (Medicare-Medicaid Plan), Illinois Health Plan Tiered Prescription Drug Lists, Making Your Health Insurance Work For You, Prescription Drug Changes and Pharmacy Information, Machine Readable Files for Transparency in Coverage. endstream
Effective May 01, 2023. *GP( @ r UQ T9 *GP( @ r UQ T9 Active Participation and Documentation of non-surgical methods of weight loss. ObesityCoverage strongly feels that morbid obesity is a disease and every insurance company should cover these life saving procedures. 2 0 obj
*GP( @ r UQ T9 If you are considering covered cardiac procedures, cancer care, knee or hip replacement, or spine surgery . 0
BCBS of Texas Criteria for Weight Loss United Healthcares Criteria For Weight Loss Surgery Coverage, Anthem BCBS Requirements for Weight Loss Surgery, Medicares Criteria For Weight Loss Surgery Coverage. *GP( @ r UQ T9 We're committed to supporting you in providing quality care and services to the members in our network. One option is Adobe Reader which has a built-in reader. Medicaids Criteria for Weight Loss Surgery Coverage. Take our bariatric surgery test! Diagnosis of Morbid obesity, defined as. An Independent Licensee of the Blue Cross and Blue Shield Association. About Us. 18. FPUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUa _AUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUU=8$ /L DG
Weight Loss Surgery Insurance Coverage Criteria, The Pouch Reset Losing Weight After Weight, These 5 Habits = Weight Loss Surgery Success. endobj
Request Out of Network Benefits. *GP( @ r UQ T9 The member must meet all requirements. 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. 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). In general, 20 percent to 30 percent above 'ideal' bodyweight, according to standard life insurance tables, constitutes obesity. 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. Before calling make sure you see our questions to ask before calling your insurance company. *GP( @ r UQ T9 Revisions to the surgery are covered by Blue Cross Michigan. *GP( @ r UQ T9 Fargo, N.D., 58121. 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. %PDF-1.6
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