In order to be pre-approved for the procedure you must meet the following requirements. Patient is over the age of 18 at the time of the surgery.
Anthem Blue Cross Blue Shield Bariatric Surgery Requirements Ausflug Dressed In Change State Chinesische Kuche Mit Margarita Und Jiaozi 饺子
18 years of age special consideration if under 18.
Anthem bcbs bariatric surgery requirements. Primary Care Physicians Letter. Patient is over the age of 18 at the time of the surgery. Medical policies and clinical utilization management UM guidelines are two resources that help us determine if a procedure is medically necessary.
If you cant or dont follow the diet after the surgery. Including surgical care post-operative care outpatient follow-up care and patient education. On February 16 2011 the FDA approved an expanded indication for the Lap-Band device to include individuals with a BMI at least 30 kgm 2 with one or more obesity related comorbid conditions.
1 gastric -restrictive procedures that create a small malabsorptive procedures which produce weight loss due to malabsorption by altering the normal transit of ingested food through the intestinal tract. These Centers have lower complication rates and fewer readmissions. Pre-Approval Requirements For Anthem BCBS.
What are the Anthem BC Georgia Criteria for Coverage. In fact most of the Blue Cross Blue Shield network has some sort of coverage for weight loss surgery. These documents are available to you as a reference when interpreting claim decisions.
Attainment or near-attainment of physiologicskeletal maturity at approximately age 13 in girls and 15 for boys. The pre-approval requirements for bariatric surgery include. Does Anthem BCBS Nevada Have Pre-Requisites For Coverage.
Does anthem cover bariatric surgery. Anthem BCBS may cover weight loss surgery as long as your policy does not specifically exclude coverage. Find a Blue Distinction CenterCenter for Bariatric Surgery.
Active Participation and Documentation of non-surgical methods of weight loss. Anthem BCBS Pre-Approval Requirements Body Mass Index BMI of 40 or greater OR a BMI of 35 or greater with at least 2 comorbidities. Prior to covering your bariatric surgery BlueCross Blue Shield typically requires a Body Mass Index BMI of 35 or greater along with a written letter describing your weight history for the last 5 years including all attempted diets exercise and weight loss programs.
Because the medically supervised weight loss program was at least 6 months long and started 2 years prior to surgery it was accepted and I got first letter approval for VSG. To be approved for the weight loss surgery you must meet the minimum requirements. Be age 18 or older Diagnosis of Morbid obesity defined as a Body Mass Index BMI greater than 40.
Bariatric surgery falls into two general categories. Blue Distinction Centers and Blue Distinction Centers for Bariatric Surgery provide a full range of bariatric surgery care. With this design change each facility can apply to achieve the BDC or BDC designation.
The short answer is yes. Selection Criteria for Adolescents. Be age 18 or older Diagnosis of Morbid obesity defined as a Body Mass Index BMI greater than 40.
You need must be between the ages of 18 and 60 years old. In order to be approved by Blue Cross Blue Shield of Kansas for bariatric surgery in the United States you must meet the following criteria. Some bariatric procedures may include both a restrictive and a malabsorptive component.
For the surgery to work you have to be ready to change the way you eat and be ready and able to follow strict rules about the way you eat. Therefore they require documentation to that effect. The eligible bariatric surgical procedures listed above unless otherwise specified are covered for individualsunder the age of 18 years when they meet ALL of the following criteria.
Letter from primary care physician. Blue Distinction Centers for Bariatric Surgery Program Selection Criteria The Program uses updated Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program MBSAQIP accreditation levels which focus on site of service. There are several factors that impact whether a service or procedure is covered under a members benefit plan.
The contract is the final word when deciding if a patient is eligible for bariatric surgery. 40 Body Mass Index BMI 35 BMI with two conditions. Requirements for Pre-Approval of Weight Loss Surgery with Blue Cross Your Anthem Blue Cross insurance policy covers weight loss surgery unless it states specifically that it excludes it.
In order to be approved by Anthem Blue Cross Blue Shield for bariatric surgery in the United States you must meet the following criteria. Bariatric Surgery with BMI less than 35 kgm 2. The pre-approval requirements for bariatric surgery include.
Patient should have Body Mass Index of over 40 or over 35 if they suffer from at least two of the following. Active partaking and certification of non-surgical weight loss techniques. 18 years old or older.
I have Anthem Blue Cross California and I had done a medically supervised weight loss program previously with a different doctor about two years prior to surgery. If your plan includes coverage then coverage is provided to patients considered to be morbidly obese. BCBS Nevada and all other insurance companies want to ensure that surgery is absolutely necessary before approving coverage.
If your BCBS insurance policy covers bariatric surgery you will be required to meet a certain set of criteria to be eligible for coverage and receive a pre approval for surgery.
