Blue cross blue shield federal bariatric surgery requirements 2020 Blue Distinction Centers and Blue Distinction Centers+ specializing in bariatric surgery offer quality care, treatment expertise and better patient results. Surgical and Anesthesia Services Provided by Physicians and Other Healthcare Professionals Page 56 You must use Preferred providers in order to receive benefits. Apr 24, 2019 · We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, or sex, including sexual orientation, gender identity, or gender expression. To verify this information, please contact the provider before you receive medical services. Services Provided by a Hospital or Other Facility, and Ambulance Services Blue Distinction® Specialty Care Note: For Standard Option, we state whether or not the calendar year deductible applies for each benefit listed in this Weight loss surgery Bariatric surgical procedures are performed to treat comorbid conditions associated with morbid obesity. I have met all my requirements, have BMI of 42 with co-morbities of obstructive sleep apnea and high blood pressure. Be sure to write down what your doctor • Tell your doctor and pharmacist about any drug, food, and other allergies you have, such as latex. Obesity Coverage feels very strongly that morbid obesity is a serious illness and that all insurance companies need to cover the life-saving techniques. There is a demonstration of participant responsibility. Malabsorptive procedures divert food from the stomach to a lower part of the digestive tract where the normal mixing of digestive fluids and absorption of nutrients cannot occur. Please review our plan brochures for more information. Find in-network bariatric surgery centers in Oklahoma with BCBSOK. There are numerous gastric and intestinal surgical techniques Find a Blue Distinction specialist for high-quality, specialty care in areas such as bariatric care, fertility and maternity care, cancer care, transplants, and more. Outpatient facility services related to specific covered hip and knee replacement or revision surgeries and certain spine surgery procedures, when performed at a designated Blue Distinction Need help managing your weight and are considering weight-loss surgery? Know your options. Learn all about the #1 health insurance choice for federal employees, retirees and their families. This guide will tell you which weight loss procedures are covered and what is required for approval if you carry BCBS Arkansas. The Blue Distinction Centers and Blue Distinction Centers+ for bariatric surgery provide a full range of services, including surgical care, post Insurance for Bariatric Surgery List of Insurance Companies with their Bariatric Surgery Qualification Requirements Aetna: Patients must be severely obese for at least 2 years; have participated in a physician-supervised exercise and nutrition program for at least 3 months (must be documented in patient’s medical records); behavior modification treatment and a psychiatric evaluation if Blue Cross Blue Shield (BCBS) insurance may cover weight loss surgery and bariatric procedures, but the extent of coverage varies greatly depending on the specific plan and state. Sep 16, 2014 · I have standard Federal Blue Cross Blue Shield in Arkansas. Bariatric surgery should be performed in appropriately selected patients, 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. Anthem Blue Cross and Blue Shield will implement the following new and revised Coverage Guidelines effective April 1, 2025. Jul 25, 2025 · The risks of reoperative bariatric surgery are higher than with primary bariatric surgery and the evidence highlights the need for careful patient selection and surgeon expertise. Jan 1, 2025 · Blue Distinction® Specialty Care We provide enhanced benefits for covered inpatient facility services related to the surgical procedures listed below, when the surgery is performed at a facility designated as a Blue Distinction Center for Knee and Hip Replacement, Blue Distinction Center for Spine Surgery, or Blue Distinction Center for Comprehensive Bariatric Surgery. Starting in 2024, the Blue Cross and Blue Shield (BCBS) Federal Employee Program (FEP) established a new medical policy for bariatric surgery (FEP 7. Have completed all my prerequisites except I have one more weigh in on Oct. If there are questions about coverage of this service, please contact Blue Cross and Blue Shield of Kansas customer service or your provider network solutions representative. Blue Distinction Centers are health care facilities that deliver quality care, safely and effectively. 2023 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus Section 5 (b). Before making a final decision, please read the Plan’s federal brochure (RI 71-017). You will want to see if they will cover Lap Band Surgery, Gastric Bypass Surgery and Gastric Sleeve Surgery. CPT codes, descriptions and data copyright ©2024 American Medical Association. Gastric sleeves, gastric bypass, lap bands and realize bands are covered procedures for bariatric surgery. This marks a departure from the previous coverage structure outlined in the members’ Service Benefit Plan brochure. Oct 5, 2017 · BCBS of Illinois covers weight loss surgery if you meet their requirements. (collectively “Horizon BCBSNJ”) insures or administers. Patient Selection Criteria: Reoperation Revision bariatric surgery OR conversion of one type of bariatric surgery to a different procedure may be considered MEDICALLY NECESSARY AND APPROPRIATE using one of the procedures identified in section III as medically necessary, for EITHER of the following indications: Treatment of surgical complications or technical failures following the original . Note: For members of the Arkansas Blue Cross Blue Shield Health Advantage Self-Insured, Employee Group, please refer to the member’s Summary Plan Description for requirements and eligibility criteria for services related to bariatric surgery. This Plan is underwritten by participating Blue Cross and Blue Shield Plans (Local Plans) that under our contract (CS 1039) with the United States Office of Personnel Management, as authorized by the Federal Providers should be knowledgeable about BCBSIL Medical Policies. Feb 1, 2024 · Starting in 2024, the Blue Cross and Blue Shield (BCBS) Federal Employee Program (FEP) has established a new medical policy for bariatric surgery (FEP 7. Bear in Procedures 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. Benefits are only available for the surgical treatment of severe obesity when provided at a Blue Distinction Specialty Care Center for Bariatric (weight loss) Surgery. 11 to complete the required supervised weigh Dec 26, 2024 · Other exceptions are Medicare Advantage and the Blue Cross and Blue Shield Service Benefit Plan (also called the Federal Employee Program or FEP). Sep 17, 2024 · Those who wish to have bariatric surgery who have Blue Cross Blue Shield health insurance may be able to have their procedure covered. TennCare’s pre-approval requirements For TennCare to cover your weight loss surgery the following are required: A body mass index of 40 or greater. Includes gastric bypass, lap band, gastric sleeve and realize band coverage requirements and documentation. Typically, candidates for bariatric surgery must meet specific medical guidelines such as a body mass index (BMI) of 40 or higher or a BMI of 35 or higher with obesity-related health conditions. Systematic reviews of studies on bariatric surgery in adolescents, who mainly received gastric bypass or laparoscopic adjustable gastric banding or sleeve gastrectomy, found significant weight loss and reductions in comorbidity outcomes with bariatric surgery. Jun 4, 2020 · Anthem Blue Cross Blue Shield's bariatric surgery requirements. Weight loss is only one of the many health benefits of Bariatric surgery, but to consider the weight loss successful, patients must keep the weight off for a minimum of five years with the help of proper diet and regular exercise. Jan 6, 2025 · Bariatric surgery is a treatment for obesity in individuals who fail to lose weight with conservative measures. There are numerous gastric and intestinal surgical techniques available. Weight loss surgery Bariatric surgical procedures are performed to treat comorbid conditions associated with morbid obesity. ) Benefits for subsequent surgery for morbid obesity, performed on an inpatient or outpatient basis, are subject to the following additional pre-surgical requirements: All criteria listed above for the initial procedure must be met again, except when the subsequent surgery is necessary to treat a complication from the prior morbid obesity surgery Note: For members of the Arkansas Blue Cross Blue Shield Health Advantage Self-Insured, Employee Group, please refer to the member’s Summary Plan Description for requirements and eligibility criteria for services related to bariatric surgery. [2] Find and download your 2025 Blue Cross and Blue Shield of Texas policy documents for individual, small group or large group market policies. You must first meet the criteria listed for insurance coverage. These standard preventive benefits apply to all fully insured lines of business but can vary for self-funded groups. Benefits Section 5 (c). The 2005 Blue Cross Blue Shield Association (BCBSA) Technology Evaluation Center (TEC) Assessment identified six comparative trials of long limb gastric bypass with Roux-en-Y anastomosis (LL-RYGBP) vs. Outpatient facility services related to specific covered hip and knee replacement or revision surgeries and certain spine surgery procedures, when performed at a designated Blue Distinction Each Anthem Blue Cross and Blue Shield California insurance policy can vary on what weight management or bariatric and gastric surgery expenses are covered or excluded, so it may be easier to have our Gastric Sleeve Insurance Coordinators verify your Blue Cross or Blue Shield Gastric Sleeve Surgery coverage for you. Which surgeries are covered by insurance and how much will it cost out of pocket? Blue Cross Blue Shield does not require that you seek surgery with an in-network surgeon. Feb 21, 2017 · BCBS CareFirst Maryland does cover weight loss surgery but you must first meet the requirements before surgery. BCBS has a network of providers that offer weight loss surgery, including gastric bypass, gastric sleeve, and gastric banding procedures. A pre-determination can be The purpose of this policy is to provide general information applicable to the administration of health benefits that Horizon Blue Cross Blue Shield of New Jersey and Horizon Healthcare of New Jersey, Inc. These Medical Policies serve as guidelines for health care benefit coverage decisions, which may vary according to the different products and benefit plans offered by BCBSIL. Medical Policy Overview & Search Medical policies are scientific documents that define the technologies, procedures, and treatments that are considered medically necessary, not medically necessary, and investigational link to investigational policy. Apr 16, 2025 · The American Society for Metabolic and Bariatric Surgery Consensus statement states weight loss can vary from about 25% to 70% of an individual’s excess body weight depending on the type of bariatric surgery that is performed (Buchwald, 2005). Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association Page 1 of 1 BARIATRIC SURGERY Bariatric Surgery Medical Policy –SUR716. For persons with health coverage from Anthem Blue Cross Shield, you’ll be delighted to know that it will cover weight loss surgery. 003 Seeking quality care for specific procedures? Let our Blue Distinction® Specialty Care program connect you with high-quality options for your complex, specialty needs. Surgical and Anesthesia Services Provided by Physicians and Other Healthcare Professionals Surgical Procedures For surgical family planning procedures, see Family Planning in Section 5 (a). For a complete quote of benefit information, please contact the local Blue Cross and Blue Shield plan on the back of the patient’s identification card. Repeat bariatric surgery, if deemed medically necessary by the PCP. Claims for the surgical treatment of morbid obesity must include documentation from the member’s provider (s) that all pre-surgical requirements have been met. Sep 27, 2025 · BCBS Florida and BCBS Federal now provide coverage for bariatric surgeries in accordance with their medical policy. Blue Distinction Centers for Bariatric Surgery The BDC for Bariatric Surgery program evaluates facilities with bariatric surgery programs that treat adult patients 18 years or older, in Comprehensive Center (with or without an on-site ICU) and Ambulatory Surgery Center (ASC) settings. Each Anthem Blue Cross and Blue Shield California insurance policy can vary on what weight management or bariatric and gastric surgery expenses are covered or excluded, so it may be easier to have our Gastric Sleeve Insurance Coordinators verify your Blue Cross or Blue Shield Gastric Sleeve Surgery coverage for you. The pre-op diet and education requirements are vague and don't have time 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 postsurgery. 01. Select a surgery center that provides high-quality care. 6 Patients must demonstrate motivation to comply with proposed post operative treatment 2025 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option Section 5. Benefit Description Outpatient facility services related to specific covered bariatric surgical procedures, when the surgery is performed at a designated Blue Distinction Center for Bariatric Surgery. Need more info on blue cross blue shield skin removal surgery coverage? Are you wondering will insurance cover skin removal after weight loss or does blue cross blue shield cover plastic surgery? Oct 5, 2017 · Blue Cross Blue Shield insurance policy coverage for bariatric surgery explained. 2024 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue FocusSection 2. Policies & GuidelinesUnable to find content with name: Site Footer 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. Weight regain following RYGB is not unusual, with individuals regaining approximately 20% to 30% of the weight they lost at 10 years postoperative (Jirapinyo, 2020). Coverage guidelines effective April 1, 2020 SPECIAL NOTE: ted Care Plus (Anthem CCC Plus) plan. Applicable FARS/DFARS apply. How Long to Get Coverage Most of the time, people who work through the required testing and obtain the necessary education may be able to DESCRIPTION Bariatric surgery is a major surgical intervention which aims to reduce weight, eliminate or improve comorbid conditions, and maintain weight loss in obese patients who have failed to achieve weight loss through lifestyle modifications. Services Provided by a Hospital or Other Facility, and Ambulance Services Blue Distinction® Specialty Care Note: For Standard Option, we state whether or not the calendar year deductible applies for each benefit listed in this Vertical banded gastroplasty (open or laparoscopic) Adjustable gastric banding (adjustable Lap-Band®) performed laparoscopically or open and consisting of an external adjustable band placed high around the stomach creating a small pouch and a small stoma. (see Policy Guidelines for bariatric surgery Jun 4, 2020 · Anthem Blue Cross Blue Shield's bariatric surgery requirements. If this is an emergency, please proceed to the nearest healthcare provider with an emergency department. Surgical services to treat severe obesity must be performed in a Blue Distinction Center for Comprehensive Bariatric Surgery. For additional Weight Programs and resources to help you manage your weight and understand how it impacts your health. Obesity Benefit Synopsis Blue Cross Blue Shield of Wyoming has updated procedure codes related to obesity coverage and preventative benefits. Medical Policy: IV-19-007 Topic: Bariatric Surgery Section: Surgery Effective Date: November 1, 2020 Issued Date: November 1, 2020 Last Revision Date: August 2020 Annual Review: August 2020 The 2005 Blue Cross Blue Shield Association (BCBSA) Technology Evaluation Center (TEC) Assessment identified six comparative trials of long limb gastric bypass with Roux-en-Y anastomosis (LL-RYGBP) vs. Obesity is an increase in body weight beyond the limitation of skeletal and physical requirements because of excessive accumulation of fat in the body. CDT codes, descriptions and data Mar 2, 2018 · Does Blue Cross Blue Shield of Alabama (BCBS) cover bariatric surgery? Learn about BCBS of Alabama’s requirements for weight-loss surgery. Find out which blue cross blue shield plan covers bariatric surgery to ease your financial burden and make informed health decisions. Blue Cross Blue Shield Association TEC Special Report: The relationship between weight loss and changes in morbidity following bariatric surgery for morbid obesity. Kaiser strung him along for a year, then denied the surgery. Seeking quality care for specific procedures? Let our Blue Distinction® Specialty Care program connect you with high-quality options for your complex, specialty needs. Facilities designated as Blue Distinction and Blue Distinction Centers+ for Bariatric Surgery have dedicated teams that provide a full range of bariatric surgical care services, including inpatient care, postoperative care, follow-up and patient education. BCBS approval? Has anyone had any problems with getting approval from Blue Cross Blue Shield? What hoops did you have to jump through? Or was it super ezpz and I should stop stressing about approval I'm trying to be prepared for all the things. May 16, 2023 · Find out if Blue Cross Blue Shield provides insurance coverage for weight loss surgery in 2024. Sep 13, 2025 · The Anthem Blue Cross insurance policy covers weight loss surgery unless specifically excluded, and to be pre-approved for the procedure, members must meet all pre-surgical requirements. Morbid obesity results in a very high-risk for weight-related Six consecutive months of participation in a medically supervised weight loss program within the setting of a pre-surgical multidisciplinary evaluation must be completed within one year before the prior approval request for the bariatric surgery. The individual has undergone multidisciplinary evaluation by an established bariatric treatment program to include medical, nutritional and mental health evaluations to determine ultimate candidacy for bariatric surgery. • non-prescription (over-the-counter) medications and nutritional supplements. All rights reserved. Outpatient facility services related to specific covered hip and knee replacement or revision surgeries and certain spine surgery procedures, when performed at a designated Blue Distinction Apr 9, 2025 · Yes, many Blue Cross Blue Shield plans do cover bariatric surgery; however, this coverage often comes with strict criteria. Vitamins and Supplements Hospitals and Doctors How To: Check If your Insurance Company Covers Bariatric Surgery Your first call to your insurance carrier is to collect information about your policy. Ask about any risks or side effects of the medication and what to avoid while taking it. Note: Prior approval is required for surgery for morbid obesity. Policy Coverage Criteria Note: Bariatric (weight loss) surgery should be performed by a surgeon with specialized training and experience in the bariatric surgery procedure used, and in an institution (facility or hospital) that includes a comprehensive bariatric surgery program. NOTE: This policy is used to determine coverage of bariatric surgery for members whose plan documents include this benefit. Dec 27, 2017 · TennCare does cover weight loss surgery for those individuals that meet certain criteria. Surgery can Learn all about the #1 health insurance choice for federal employees, retirees and their families. If individual has had bariatric surgery and experienced significant weight loss, a panniculectomy should not be performed until at least 18 months after surgery and only after weight has been stable for the most recent 6 months. Six consecutive months of participation in a medically supervised weight loss program within the setting of a pre-surgical multidisciplinary evaluation must be completed within one year before the prior approval request for the bariatric surgery. Jan 3, 2013 · Background Bariatric Surgery Bariatric surgery is performed to treat morbid (clinically severe) obesity. Learn more about the Blue Distinction program. Need some advice please. Blue Distinction Centers+ recognize health care facilities that deliver more affordable care in addition to quality care Select a surgery center that provides high-quality care. Preventive diet, behavioral, and medical counseling are permitted for obesity under the US Preventive Service Task Force recommendations. standard RYGBP. These centers have lower complication rates and fewer readmissions. Benefit Description Surgical Procedures (cont. Healthcare providers can find the resources they need to check prior authorization requirements, make requests, and reference medical policies for AZ Blue members. Surgery can For example, if you use a Non-member facility that charges $60,000 for facility care related to outpatient bariatric surgery, and we pay the $1,625 amount illustrated above, you would owe $58,375 ($60,000 - $1,625 = $58,375). Learn the criteria for Blue Distinction Centers for Bariatric Surgery and find a center near you. © 2025 Blue Cross and Blue Shield of Alabama is an independent licensee of the Blue Cross and Blue Shield Association. You must also make long-term healthy changes to your diet and exercise to lose and keep weight off, even after your surgery. Documentation of patient participation in a medically-supervised weight loss program, to include nutritional o Sleeve gastrectomy counseling, for at least 3 months prior to surgery date. The Empire BCBS clinical guidelines are here. Looking to get bariatric surgery for spouse, who meets the BMI and multiple comorbidity requirements. Jul 15, 2024 · Blue Cross Blue Shield (BCBS) is one of the largest health insurance providers in the United States, and their approval process for bariatric surgery can vary depending on the specific plan and state. Breast reduction or augmentation not related to treatment of cancer For persons with health coverage from Anthem Blue Cross Shield, you’ll be delighted to know that it will cover weight loss surgery. According to standard life insurance tables, obesity is constituted as 20 to 30 percent above "ideal" bodyweight. Jun 21, 2019 · BCBS Federal Employee Program and BCBS Florida's guidelines and criteria for coverage of weight loss surgery. A provider’s participation in the program is subject to change. (collectively referred to as "Louisiana Blue") have developed these medical policies to serve as general coverage guidelines for determining if a particular treatment, procedure or other service may be considered as a covered benefit. *If another carrier is primary (such as Medicare), prior approval/pre-certification may be Benefit Description Outpatient facility services related to specific covered bariatric surgical procedures, when the surgery is performed at a designated Blue Distinction Center for Bariatric Surgery. Which surgeries are covered by insurance and how much will it cost out of pocket? Benefit Description Surgical Procedures (cont. Restrictive procedures restrict the size of the stomach and decrease intake. Switching from Kaiser Mid-Atlantic (living in VA) to BCBS during open season. Changes for 2024Section 2. Aug 22, 2020 · Consider medical tourism —plastic surgery procedures in countries like Mexico are often more affordable. 47 bariatric surgery). This health insurance company has several plans, but not all provide coverage for any type of weight loss procedure. Which surgeries are covered by insurance and how much will it cost out of pocket? Executive Summary In late 2016, local Blue Plans invited 1,775 facilities across the country (consisting of comprehensive acute care inpatient facilities and ambulatory surgery centers) to be considered for the Bariatric Surgery designation under this Program; over 750 facilities applied and were evaluated on objective, transparent selection criteria with quality, business, and cost of care 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 postsurgery. In 2011 TennCare adopted the guidelines that Blue Cross Blue Shield uses for bariatric surgery. Providers should be knowledgeable about BCBSIL Medical Policies. A predetermination can be requested for our PPO products. The main reasons for recommending bariatric surgery for adolescents included: (1) surgery is effective in producing short- and long-term weight loss; (2) surgery is appropriate when the patient does not respond to behavioral or medical interventions; (3) surgery is appropriate when serious comorbidities threaten the health of the patient; and CPT codes, descriptions and data copyright ©2024 American Medical Association. The Program Selection Criteria outlines the Quality, Business, and Cost of Care Selection Criteria and evaluation processes used to determine eligibility for the Blue Distinction® Centers (BDC) for Bariatric Surgery program (this Program). (see Policy Guidelines for bariatric surgery Jul 25, 2025 · Dilatation of the gastrojejunal anastomosis or the gastric pouch following the initial bariatric surgery causes insufficient weight loss or weight recidivism. 01. Morbid obesity is Blue Cross Blue Shield of Louisiana and its subsidiary, HMO Louisiana, Inc. This article looks at what criteria is necessary for Lap Band, gastric bypass, and gastric sleeve surgery. Many who have sustained Jan 22, 2019 · Does Blue Cross Blue Shield cover bariatric surgery for federal employees? The answer is yes, subject to your eligibility for the BCBS federal employees program. Other exceptions are Medicare Advantage and the Blue Cross and Blue Shield Service Benefit Plan (also calle the Federal Employee Program or FEP). The majority of the Blue Cross Blue Shield network has some kind of weight loss surgery coverage. Description Bariatric surgery is a treatment for class III obesity in patients who fail to lose weight with conservative measures. Oct 7, 2024 · II. If the member’s contract benefits differ from the medical policy, the contract prevails. Description: Bariatric surgery is a treatment for obesity in patients who fail to lose weight with conservative measures. Learn about eligibility, procedure details, and policy updates in our in-depth coverage guide. Policies may be archived when the technology is considered obsolete, has been discontinued, or has become standard of care with well-established usage guidelines. When multiple surgical procedures that add time or complexity to patient care are performed during the same operative session, the Local Plan determines our allowance for the combination of Jan 14, 2023 · Blue Cross Blue Shield Association TEC Special Report: The relationship between weight loss and changes in morbidity following bariatric surgery for morbid obesity. 5 kg/m2 for Asian individuals) or for adolescents 120% of the 95th percentile for age and sex (whichever is lower) with at least one clinically significant obesity-related disease, including but not limited to: Type 1 or 2 diabetes mellitus The Blue Cross and Blue Shield Association does not intend by the FEP Medical Policy Manual, or by any particular medical policy, to recommend, advocate, encourage or discourage any particular medical technologies. Apr 19, 2025 · What are the requirements for BCBS to cover weight loss surgery? Blue Cross Blue Shield (BCBS) Insurance covers weight loss surgeries deemed medically necessary and recognized by medical professionals as effective for significant weight loss. o Biliopancreatic bypass with duodenal switch Jun 21, 2019 · BCBS Federal Employee Program and BCBS Florida's guidelines and criteria for coverage of weight loss surgery. Our medical policies help us determine what technology, procedure, treatment, supply, equipment, drug, or other service we’ll cover. Feb 18, 2025 · Understand Blue Cross Blue Shield’s coverage for weight loss surgery, including eligibility requirements, approval steps, limitations, and potential costs. One key highlight of the new policy is the expansion of eligibility to adolescents. See below and Section 3 for the exceptions to this requirement. Please review the individual plan document to determine if coverage is available. Morbid obesity results in a very high-risk for weight-related This is a summary of the features of the Blue Cross and Blue Shield Service Benefit Plan. To help members find hospitals and surgery facilities that provide high-quality bariatric surgery care, Blue Cross Blue Shield of Michigan and Blue Care Network join Blue plans across the country in designating Blue Distinction Centers and Blue Distinction Centers+ for Bariatric Surgery. Although a service, supply or procedure A BMI greater than or equal to 30 kg/m2 (27. Morbid obesity is defined as a body mass index (BMI) greater than 40 kg/m 2 or a BMI greater than 35 kg/m 2 with associated complications including, but not limited to, diabetes, hypertension, or obstructive sleep apnea. Your employer or other plan sponsor may exclude bariatric coverage so it would still be good to call and check, though excluding coverage in New York is relatively unlikely since bariatric surgery is an "essential health benefit" and must be covered by most health plans. In this comprehensive guide, we’ll explore the factors that influence the approval timeline for bariatric surgery with BCBS, the steps involved Smith et al (2018) published a retrospective study which indicated that individuals who have undergone body contouring after bariatric surgery are able to lose significantly more weight and maintain weight loss at 5 years of follow up compared to those undergoing bariatric surgery alone. Jun 4, 2020 · BCBS of Texas covers weight loss surgery, including gastric bypass, lap bands, and gastric sleeve surgery. They do recommend that you utilize their in-network surgeons, however, in order to take advantage of their Center of Excellence. Which Federal BCBS Plan for Bariatric Surgery? Hi y’all. The Blue Cross® and Blue Shield® words and symbols, Federal Employee Program®, FEP®, MyBlue® and Blue365® are all trademarks owned by Blue Cross Blue Shield Association. 2025 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus Section 5(b). Note: This evidence review will only address surgical and minimally invasive procedures that are considered investigational. Aug 24, 2020 · 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. Feb 24, 2012 · Federal Employee Program members only require prior approval* or pre-certification* on the following services, which are based on medical necessity. CDT codes, descriptions and data copyright ©2024 American Dental Association. In April 2020, the FDA provided an update on risks and continued to recommend that healthcare providers "instruct patients about the symptoms of life-threatening complications such as balloon deflation, gastrointestinal obstruction, and gastric and esophageal perforation and monitor patients closely during the entire duration of treatment for potential complications, including acute Executive Summary In late 2016, local Blue Plans invited 1,775 facilities across the country (consisting of comprehensive acute care inpatient facilities and ambulatory surgery centers) to be considered for the Bariatric Surgery designation under this Program; over 750 facilities applied and were evaluated on objective, transparent selection criteria with quality, business, and cost of care Jun 21, 2019 · BCBS Federal Employee Program and BCBS Florida's guidelines and criteria for coverage of weight loss surgery.