blue cross blue shield bariatric surgery requirements 2022

Individuals should have documented failure to respond to conservative measures for weight reduction prior to consideration of bariatric surgery, and these attempts should be reviewed by the practitioner prior to seeking approval for the surgical procedure. Medicaids Criteria for Weight Loss Surgery Coverage. outpatient follow-up. *GP( @ r UQ T9 Procedures . 5 0 obj *GP( @ r UQ T9 To qualify for coverage of weight loss surgery, your policy must include coverage. Medical Policy #: 02.01.56 . 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 . Complications can include but are not limited to fistula, obstruction or disruption of a suture/staple line. *GP( @ r UQ T9 x *GP( @ r UQ T9 0 *GP( @ r UQ T9 Accept Read More, Anthem BCBS Requirements for Weight Loss Surgery, Gastric Sleeve Surgery Will My Stomach Stretch, Vitamin Guidelines After Bariatric Surgery, Gastric Sleeve Surgery The Complete Guide, Recovery From Gastric Sleeve What To Expect, Recovery From Lap Band Surgery What To, Gastric Bypass Vs. Gastric Sleeve Surgery, Expected Weight Loss From Gastric Bypass Calculator, 5 Ways to Prevent Stretching Your Stomach After, How Much Will You Weigh After Surgery Calculator, Cost of Gastric Sleeve (Sleeve Gastrectomy) Surgery, Lap Band Compared to Gastric Bypass Surgery, Mini-Gastric Bypass The Good, Bad, And Ugly. Provider Resource Center - BCBSWNY Centers for Bariatric Surgery. *GP( @ r UQ T9 QHP Small Group Actual Policy Documents; . 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. (EGD) are considered an integral component of all bariatric procedures and are not eligible for separate payment when reported on the same day as the bariatric surgical procedure. Medical Policy Update is a monthly newsletter for the health care providers who participate in our networks and submit claims to Highmark Blue Cross Blue Shield of Western New York (Highmark BCBSWNY) using the appropriate HIPAA transactions or claim forms as required by Highmark BCBSWNY.This publication focuses only on medical policy and claims administration updates, including coding . You can also locate a contact number and email address on their website after choosing your state. *GP( @ r UQ T9 Blue Distinction Centers for Bariatric Surgery, along with the Blue Distinction . 0 Does Blue Cross Blue Shield of Alabama (BCBS) cover bariatric surgery? `FlM->e4m[OQ[M49%^B-:qfI_xEk/rMaEvA:Q9IZTq('IfPp(TM|:m)eoYZ2wtguH"tzxgf=JLu)RyN0 Please refer to the criteria listed below for genetic testing. Bariatric surgery in patients with diabetes and body mass index less than 35 kg/m 2. *GP( @ r UQ T9 and patient education. The site may also contain non-Medicare related information. The Center of Excellence should also hold a certification by the American Society for Bariatric Surgery as a bariatric surgery Center of Excellence. bariatric surgery. *GP( @ r UQ T9 Blue Distinction Centers and Blue Distinction Centers+ for Bariatric Surgery offer a full range of bariatric surgery care, including: surgical. *GP( @ r UQ T9 stream patient education. post-op. Blue Distinction Centers for Bariatric Surgery | Blue Shield of CA All rights . 1238 0 obj <>stream PDF FEP Blue Focus Prior Approval List - Premera Blue Cross *GP( @ r UQ T9 *GP( @ r UQ T9 Liq V8 K+%w\R,XXXYY&1]yxh~C%k.2 MeOaLd9 sG@Afd`}w U This policy provides direction on Blue Cross Blue Shield of North Dakota (BCBSND) reimbursement for global surgical package and subsequent services provided within the global surgery days. Revised: July 2022. FPUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUa _AUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUU=8$ /L DG 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. <> Provider Policies, Guidelines and Manuals | Anthem.com <> If you have Original Medicare, Part A and Part B, you can call Medicare at 1-800-MEDICARE . <> Blue Cross and Blue Shield's Federal Employee Program Benefit Plans Brochures and Forms Webpage . PDF Bariatric Surgery Selection Criteria - Blue Cross Blue Shield Association October 2017. Policies, Guidelines & Manuals. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. Blue Distinction Specialty Care *GP( @ r UQ T9 What is a Weight Loss Seminar? endobj No. This site complies with the HONcode standard for trustworthy health information: Verify here. View Medical Policies | Excellus BlueCross BlueShield Directory ofBlue Distinction Centers and Blue Distinction Centers+ for Bariatric Surgery, Program Selection Criteria For Bariatric Surgery. Read information on bariatric procedures, guides, find a surgeon and more. there are documented recurrent or chronic rashes, infections, cellulitis, or non-healing ulcers, that do . Morbid obesity is defined as a body mass index (BMI) greater than 40 kg/m2 or a BMI greater than 35 kg/m2 with associated complications including, but not limited to, diabetes, hypertension, or obstructive sleep apnea. *GP( @ r UQ T9 Bariatric procedures not meeting the criteria as indicated in this policy are considered not medically necessary. endstream endobj 749 0 obj <. *GP( @ r UQ T9 *GP( @ r UQ T9 Blue Cross covers services for the treatment of obesity, weight management, eating disorders, nutrition and physical activity counseling. Blue Distinction Centers and Blue Distinction Centers+ for Bariatric Surgery offer a full range of bariatric surgery care, including: These centers have lower complication rates and fewer readmissions. *GP( @ r UQ T9 endobj 14 0 obj Full coverage for a weight loss surgery procedure will be provided to a patient with a Body Mass Index (BMI) over 40. So, to find out if your policy includes coverage, please talk directly to Blue Cross Michigan. endobj Target Fair Price: $12,250. Please contact BCBS of Michigan directly to find out if they offer coverage for a second procedure. Covered Diagnosis Codes for Procedure Codes: 43644, 43770, 43775, 43843, 43846, and S2083, Covered Diagnosis Codes for Procedure Code: 43845, Internal Medical Policy Committee 3-16-2020 Revision, Internal Medical Policy Committee 11-19-2020 Revision, Internal Medical Policy Committee 11-23-2021 Revision. Or. 1J-z](5K+XkXU)zc+2gUnRsXuQ@t>icv- {7V}*ymha.JS10NL](wnj`"5c+8L5TwB0mgbP{C]Z#H4:s PCD4N0"Pz}KP7A@mDY*/yiI @Z22*;/-"i1-mhqe,@e*De)KW8vYiI @Z22*;/-"iq@M&, e * PY$(NY`!%'NZ2 AHTyiHV}%0D0r, e9(KDElW4m'NZ2 AHTyiHm>e ,@e(, 8e"Q4Z'NZ2 AHTyiHu}fOY? e,@e*bs HYA$RV A*6 bhu/D0Cxi9 H! 4510 13th Ave. S. Conservative measures for weight reduction should include changes to the individual's dietary, medication, and exercise regimen; The individual must complete a multidisciplinary evaluation including medical, nutritional, and psychological evaluations. A representative will contact you within one to two business days to help you schedule an appointment. 15 0 obj *GP( @ r UQ T9 *GP( @ r UQ T9 Medical Policy - Highmark Surgeon: James Stephen Scott. An Independent Licensee of the Blue Cross and Blue Shield Association. *GP( @ r UQ T9 of the adolescent selection criteria for bariatric surgery, the procedure will be denied as not medically necessary. *GP( @ r UQ T9 %%EOF *GP( @ r UQ T9 External link You are leaving this website/app (site). 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. "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 . If you are planning on having any of the above weight loss procedures and you meet the pre-approval requirements, you should schedule an initial meeting with your Bariatric surgeon of choice who will give you an overview of the process as he/she reviews your health history to confirm eligibility. No specific information regarding the requirement of an in-network surgeon is available. Primary Care Physician's Letter. We recommend that you only use this publication in conjunction with the current year's health premium rate schedule and EOCs. *GP( @ r UQ T9 TTY users can call 1-877-486-2048. a Body Mass Index (BMI) greater than 40. Here you will find information for assessing coverage options, guidelines for clinical utilization management, practice policies, the provider manual and support for delivering benefits to our members. In addition, some sites may require you to agree to their terms of use and privacy policy. If the individual does not meetALLof the selection criteria for bariatric surgery, the procedure will be denied as not medically necessary. The eligible bariatric surgical procedures listed above unless otherwise specified may be considered medically necessary for individuals under the age of 18 years when they meet Psychiatric Residential Treatment Request Form. To obtain a copy of the health premium 2019 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus. Individual outcomes may vary. Access Your Payment Options. If you have symptoms of an urgent nature, please call your doctor or go to . This will depend on the type of policy you have purchased. Bariatric Surgery for Obesity - UChicago Medicine Coverage is typically only offered if you followed the post-operative guidelines, changed your lifestyle and sought help from your bariatric surgeon, dietitian and other resources. <> PPO outpatient services do not require Pre-Service Review. *GP( @ r UQ T9 Pre-Cert/Pre-Auth (In-Network) - CareFirst 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. endobj bluecross blueshield fed blue bariatric Guide bluecross blueshield fed blue bariatric Requirements bluecross blueshield fed blue bariatric web address bluecross blueshield fed blue bariatric valid Username & Password. The best option is to call them directly and ask if your policy includes coverage for CPT Code 43775. 2 0 obj *GP( @ r UQ T9 Surgery Date: 03/24/2015. *GP( @ r UQ T9 External link You are leaving this website/app (site). . 13 0 obj In general, 20% to 30% above "ideal" bodyweight, according to standard life insurance tables, constitutes obesity. Which Bariatric Surgery is Best? We lowered the age we will begin covering weight-loss (bariatric) surgery for members to age 16. endobj Substantially impaired quality of life or activities of daily living; Moderate to severe OSA (apnea-hypopnea index greater than 15); Individuals must have documented failure to respond to conservative measures for weight reduction prior to consideration of bariatric surgery, and these attempts should be reviewed by the practitioner prior to seeking approval for the surgical procedure. Section 3. *GP( @ r UQ T9 of the selection criteria are met. *GP( @ r UQ T9 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. 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. endobj F(wG((|1]) Global Surgical Package | BCBSND *GP( @ r UQ T9 *GP( @ r UQ T9 Anthems full policy on weight loss surgery insurance coverage is no longer available online. Northeast Georgia Medical Center (NGMC) offers a variety of surgical and nonsurgical weight-loss options and is an Anthem Blue Cross Blue Shield Blue Distinction Center for Bariatric Surgery. 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. *GP( @ r UQ T9 Learn more about weight loss surgery at Rocky Mountain Associated Physicians www.RMAP.com (801) 268-3800. This new site may be offered by a vendor or an independent third party. 1 0 obj Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. Blue Cross and Blue Shield is an association of . VII. *GP( @ r UQ T9 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 . Contact information for your Anthem BCBS is listed below. of the following criteria is met: Individual postoperative noncompliance negates the efficacy of revision or conversion surgery. 2 0 obj *GP( @ r UQ T9 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. All rights reserved. PDF REIMBURSEMENT POLICY Weight Management Care - Blue Cross MN 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. The 2022 health plan premiums are available at the CalPERS. outpatient follow-up. 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. 1 0 obj *GP( @ r UQ T9 stream Contact 866-773-2884 for authorization regarding treatment. @h23Begj!b4ZJ2}Y*bPc6d 5d 05dD/Br,Fsr#0Yi^kRsTCx aEt! Repeat or Revised Bariatric Surgical Procedures. However, your deductible and out of pocket costs may be significantly lower if you do. 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. Forms | Providers | BlueCare Tennessee - BCBST Origination: Last Review: Description of Procedure or Service . "Our comprehensive program helps patients [] endstream endobj 1203 0 obj <.

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