blue cross blue shield bariatric surgery requirements 2022

Starting in Fall of 2022, FEP Blue Focus members can receive a . For enrollment codes 131, 132, 133 (on the member's ID card) Failure to obtain Pre-certification of an inpatient hospital admission will result in a $500 penalty to the preferred provider. Typically, Blue Cross Blue Shield does offer coverage if your primary procedure does not produce the expected results. The duration of the weight loss program should have been at least twelve consecutive months. <> Internal Medical Policy Committee 1-20-2022 Revision with coding updates; Internal Medical Policy Committee 11-29-2022 Coding update - 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. Review: Prosper Healthcare Lending Should You Choose it for Bariatric Surgery Financing? <>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 17 0 R 18 0 R 19 0 R 20 0 R 21 0 R 22 0 R 23 0 R 24 0 R 25 0 R 26 0 R 27 0 R 28 0 R 29 0 R 30 0 R 31 0 R 32 0 R 33 0 R 34 0 R 35 0 R 36 0 R 37 0 R 38 0 R 39 0 R] /MediaBox[ 0 0 960 540] /Contents 16 0 R/Group<>/Tabs/S/StructParents 1>> when 2 0 obj Even when a policy covers weight loss surgery for qualifying patients, some situations may lead to a denial such as: You or your doctor can write a letter of appeal to the insurance company to appeal, you must, however, provide documentation for all the criteria listed in the policy as well as those from your previous communications with your insurance company about the surgery. Bariatric Surgery | Blue Cross and Blue Shield of Oklahoma - BCBSOK Returning Shopper? *GP( @ r UQ T9 Sitemap, Bariatric Surgery 101 Guide: Read This First. The following are three types of weight loss procedures that are covered by BCBS Alabama. Goal Weight: 149 lbs. Policy: 7.01.47 Effective Date: Nov. 1, 2022 Last Revised: Jan. 1, 2023 Replaces: 7.01.47 RELATED MEDICAL POLICIES: 2.01.38 Transesophageal Endoscopic Therapies for Gastroesophageal Reflux Disease 7.01.522 Gastric Electrical Stimulation . One of the most common questions asked by prospective patients is, "Will my insurance cover Weight Loss Surgery, and what requirements do I have to meet in order to qualify?". The site may also contain non-Medicare related information. 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. *GP( @ r UQ T9 Blue Cross Requirements for Weight Loss Surgery - Obesity Reporter %PDF-1.5 *GP( @ r UQ T9 2019 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus. Outpatient Facility Average: $16,150. Information regarding coverage of a second weight loss surgery is not available. *GP( @ r UQ T9 Height: 5 feet 6 inches. Blue Cross and Blue Shield's Federal Employee Program Benefit Plans Brochures and Forms Webpage . @h23Begj!b4ZJ2}Y*bPc6d 5d 05dD/Br,Fsr#0Yi^kRsTCx aEt! To view this file, you may need to install a PDF reader program. B#UVjHJ)Uc_;(T;ZAYQ}_B4UC3{mo No. If you have Original Medicare, Part A and Part B, you can call Medicare at 1-800-MEDICARE . Please contact BCBS of Michigan directly to find out if they offer coverage for a second procedure. We'll assume you're ok with this, but you can opt-out if you wish. stream *GP( @ r UQ T9 Less than 18 years of age and has attained Tanner 4 or 5 pubertal . Policies, Guidelines & Manuals. and patient education. Individual outcomes may vary. Centers for Bariatric Surgery. 1202 0 obj <> endobj This new site may be offered by a vendor or an independent third party. 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. 18 - FEP Blue Focus Active Participation and Documentation of non-surgical methods of weight loss. accredited by the metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, . *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. xV]:}G?c;HU]zU?G\} 29gfjL}a? TJicTrXbfWllWfrZIUOzp*k}`o. 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. These may include: The weight loss surgery should have been prescribed by a physician other than the operating surgeon. 24/7 online access to account transactions and other useful resources, help to ensure that your account information is available to you any time of the day or night. Blue Cross Blue Shield of Minnesota Medical Policy Bariatric Surgery in Adolescents and Children Return to Clinical Indications. *GP( @ r UQ T9 2022 Policy Documents. [oH:kv=(@me_Wu C w/n7}3N$*hX|! States Where Insurance Is Required To Cover Bariatric Surgery Under the Affordable Care Acts Essential Health Benefits Benchmark Plans, 23 states require that all individual, family, and small group insurance plans cover . | 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. 6/2022 . What is a Weight Loss Seminar? *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. 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. 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