Saturday, April 13, 2024

How Long Does It Take Bcbs To Approve Bariatric Surgery

Can I Buy Insurance To Cover Bariatric Surgery

Gastric bypass surgery: the procedure

Bariatric surgery can be covered by both private commercial and government-sponsored insurance programs, says Dr. Garber. However, there are no special types of insurance that will cover this type of procedure. If you intend to undergo weight loss surgery, but your current policy does not cover it, you have the option to enroll in a new policy during open enrollment that does provide coverage for bariatric surgery.

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Knowing and consistently applying the latest criteria from each insurance company is critical to ensuring your patients are able to be approved for surgery.. You can further simplify the insurance process for you and your patients by using the latest tools to help tailor the evaluation requirements and streamline the pre-authorization process.

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What Will My Out Of Pocket Expenses Be

Once again, exact coverage will depend your group benefits, so we suggest that you either call BCBS Alabama directly or speak to your HR department at work. At your office consult, you will meet with our Bariatric Coordinator who will go over your benefits and obligations.

Remember that your plan will most likely have calendar year deductibles, co-insurances and out of pocket maximums that reset on January 1. If you are approaching the end of the year, your actual out of pocket expenses may be lower if you have already paid for medical treatment earlier in the year.

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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 bariatric surgery. Those states are:

Also under the ACA, in the following three states, bariatric surgery coverage must be offered in at least some policies:

  • Georgia, where a 1999 state law also mandates coverage for morbid obesity
  • Indiana, where a 2000 state law also mandates coverage for morbid obesity
  • Virginia, where a 2000 state law also mandates that coverage for morbid obesity must be offered in at least one plan by each state-regulated health insurer

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How To Contact Blue Cross Blue Shield Of Alabama

How long does a Blue Cross approval take??

Blue Cross Blue Shield of Alabama can be contacted via email or telephone. You may need to call a different number depending on the type of plan you have. Please follow this link to see all contact options:

Do you live outside of Alabama? Get out-of-state Blue Cross Blue Shield plan information?

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What To Do If Youre Denied

A pre-approval does not necessarily guarantee coverage and we will help you in any way possible to ensure that your coverage is not denied. Sometimes, however, patients will receive a denial anyway. This is when you should first contact your insurance provider and request the denial in writing, with the reason clearly stated. Second, bring this denial to our bariatric coordinator and we will help you analyze it and submit a response or appeal.

What States Require Insurance Companies To Cover Weight Loss Surgery

As mentioned, about half of the states in the U.S. require ACA-compliant health plans to cover weight loss surgery for all patients who qualify for these procedures. Keep in mind that this does not apply to private health plans or group health plans. According to Dr. Garber, these 23 states include weight loss surgery as an Essential Health Benefit with every Marketplace health plan:

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Does Health Insurance Cover Gastric Sleeves

The gastric sleeve is one of the safest and most reliable surgical options for long-term weight loss, says Dr. Garber. As a result, many insurance providers will provide coverage for a gastric sleeve procedure, but you should check with your insurance provider to see what your plan covers. Like all types of bariatric surgery, you may need to meet certain requirements before your insurance provider will pre-authorize gastric sleeve surgery.

Does Blue Cross Blue Shield Cover Weightloss Surgery

Bariatric Surgery Full Liquid Diet

Does Blue Cross Blue Shield Cover Weightloss Surgery?

Does Blue Cross Blue Shield Cover Weightloss Surgery?

Does Blue Cross Blue Shield Cover Weightloss Surgery? On average, it will take Blue Cross Blue Shield 30 days to approve your request for bariatric surgery. So, if you want to have weight loss surgery that is covered by your insurance, you should plan ahead and keep track of how long it takes to get BCBS approval.

First, choose a hospital or bariatric surgeon who can help you meet the BCBS approval conditions quickly and will follow up with them on your behalf. Prepare all the paperwork that BCBS may need, such as health records, medical tests, a report on your diet and exercise, and a certificate from a class on changing your behavior .

The BCBS appeals process says that you can still file an appeal if Blue Cross Blue Shield does not approve your pre-authorization for bariatric surgery. With help from your surgeon, be ready to respond to every reason theyve given to turn down your request for coverage. Follow the exact rules of the BCBS appeals process and file your appeal within the time limit.

If BCBS doesnt approve your bariatric surgery and your appeal is also denied, that doesnt mean you have to deny yourself good health and a long life. Check out options for low-cost bariatric surgery, like medical tourism with a reputable service provider. This will help you lose weight and get your health back without going over your budget.

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Procedures That Are Not Covered

The following procedures are NOT covered by Anthem Blue Cross Blue Shield:

  • Biliopancreatic bypass without duodenal switch
  • Very long limb gastric bypass
  • Revision Surgery
  • General Appeal Instructions
  • Appeal Details Specific to Anthem Blue Cross Blue Shield

If Anthem Blue Cross Blue Shield denies your weight loss surgery claim and you think it should be covered, consider filing an appeal.

Our Health Insurance Appeals page will get you started, then head over to the Disputes & Appeals page for Anthem Blue Cross Blue Shield to learn how to proceed.

Services That Need Approval

Depending on what type of plan you have, we may need to review and approve some of your health care services before we cover them. We call this prior authorization.

If you need preapproval, your doctor or health care professional will request a review on your behalf. Once we get the request, we’ll begin the review process. So, it’s important they send us all the materials we need for your review, up front.

If you’re looking for more information about prescription drug prior authorization, read Why do I need prior authorization for a prescription drug?

There are four types of review for health care services:

  • Preservice non-urgent review: When you need to get a certain health care service, but it isn’t urgent. It can take up to 15 days for us to make our decision. This is the most common type of review.
  • Preservice urgent review: When you need to get a certain health care service as soon as possible, but it isn’t an emergency. It can take up to three days for us to make our decision.
  • Urgent concurrent review: When you’re already getting care and you can’t wait to get approval for it. This often happens with trips to the emergency room. It can take up to 24 hours for us to make our decision.
  • Postservice review: When you’ve already gotten the care you need and you request approval for it. It can take up to 30 days for us to make a decision.

If you disagree with our decision, you can appeal.

Here are some services that need approval. This is not a full list.

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Approved By Governing Bodies:

Forms of bariatric surgery performed without specific implantable devices are surgical procedures that are not regulated by FDA.

Table 12 shows forms of bariatric surgery with implantable devices approved by the FDA through the premarket approval process.

Table 12: FDA-Approved Bariatric Surgery Devices

Device

Ethicon Endosurgery

For use in weight reduction for morbidly obese patients and for individuals with BMI of at least 40 kg/m2, or a BMI of at least 35 kg/m2 with 1 comorbid conditions, or those who are 45.4 kg over their estimated ideal weight. Indicated for use only in morbidly obese adults who have failed more conservative weight-reduction alternatives .

LAP-BANDÒ Adjustable Gastric Banding System

ReShape Lifesciences

May 2019

For use in weight reduction for severely obese adults with BMI of at least 40 kg/m2 or a BMI of at least 30 kg/m2 with 1 severe comorbid conditions who have failed more conservative weight-reduction alternatives .

BMI: body mass index: FDA: Food and Drug Administration PMA: premarket approval.

General Requirements For Coverage Of Bariatric Surgery

BCBS and getting approved. How long does it take ?!

Please note that the requirements below are not comprehensive and may change. Always speak to Blue Cross Blue Shield of Arizona or our office to understand the most up-to-date requirements for coverage. Blue Cross Blue Shield Arizona will have a number of general requirements. Some may be specific to your medical situation. In general, the following are necessary for coverage:

While completing all of the steps above and obtaining a preauthorization gets us most of the way there, it does not guarantee coverage. There are occasions in which clerical errors cause a rejection of coverage. These are usually easily rectified, and you should not panic if you receive a denial. We will work with you to correct errors and overturn that denial through an appeal. Learn more about what to do if your bariatric surgery coverage is denied.

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The Communication Phase : How Long Does It Take Bcbs To Approve Bariatric Surgery

Finally, when it comes to surgery, BCBS does not force you to see an in-network surgeon. However, in order to take advantage of their Center of Excellence, they do recommend that you use their in-network surgeons. If you want to consider these professionals for your operation, you may get a list of them from your BCBS representative. Make certain that the person you want to deal with can submit directly to BCBS for coverage of your treatment.

What Are The Requirements For Coverage Of Weight Loss Surgery

Requirements for surgery coverage will vary between each plan and the groups benefits. These general guidelines for pre-approval of bariatric surgery are standard, but specific requirements may be unique to your policy:

  • BMI: A body mass index or BMI of 40 or greater or a BMI of 35 or greater with one or more associated medical conditions is typically the first requirement for bariatric surgery candidates. Associated diseases may include diabetes, high blood pressure, severe sleep apnea, and more.
  • Obesity Diagnosis: A diagnosis of morbid obesity must be indicated in the patients medical records before surgery . Your primary care providers attestation and dated photographs may be accepted if morbid obesity has not been documented.
  • Supervised Weight Loss Program: Depending on the details of your plan, patients may be required to have documentation of physician-supervised weight loss attempts over the past 12 months. This may require proof of three, six, nine, or 12 months of participation. Some policies do not include this requirement. Other policies may ask for documentation of participation in other non-surgical weight loss programs like support programs such as Jenny Craig, Weight Watchers, and more.
  • Smoking Cessation: All patients must cease smoking at least eight weeks before surgery.

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What Will My Out

Exact coverage for surgery will vary based on your benefits. We encourage patients to call BCBS Florida Blue directly using the phone number on your insurance card or speak to your HR department for policies through your employer. During your office consultation, our Bariatric Coordinator will spend time with you to review your specific benefits and obligations, including what may be required for coverage.

Many plans have deductibles, co-insurance, and out-of-pocket maximums that reset with the calendar year each January 1st. If you are approaching the end of the year, your out-of-pocket surgery expenses may be lower if you have already paid for medical treatment earlier in the year. Please keep in mind that several required visits may be required before surgery. It is best to plan several months in advance, even if you take advantage of a paid deductible or met the out-of-pocket max for bariatric surgery.

Blue Cross Blue Shield Insurance Coverage For Bariatric Surgery

Bariatric Surgery: What to Expect with Weight Loss and Whole Health Improvement

Did you know that Federal Blue Cross Blue Shield Insurance helps pay for bariatric surgery? If you have an Federal Blue Cross Blue Shield policy contact us today to schedule an initial consultation.

Federal Blue Cross Blue Shield also has a reduced pre-op process that allows you to get your bariatric surgery in just three months, instead of the traditional six! To get started on your surgery process, call us today!

Federal Blue Cross Blue Shield policyholders are eligible for surgery at Providence Alaska Medical Center, where youll receive the best care from the nationally-recognized MBASQIP Bariatric Surgery Center of Excellence, overseen by our own surgeons, Dr. Justin Clark and Dr. Sean Lee.

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Help Bariatric Surgery Is Excluded From My Bcbs Planwhat Do I Do

Unfortunately, not every plan or group will include coverage for weight loss surgery, but that does not spell the end of your journey. There are financing and cash pay options that may suit your needs. If you do not have insurance for surgery, we ask that you call our office to learn more about how we can help you. You may also wish to contact the HR department at your workplace to see if they have incentives for weight loss and bariatric surgery.

Blue Cross Blue Shield Alabama Bariatric Surgery Insurance Coverage

Blue Cross Blue Shield of Alabama is our states largest health insurance provider with over 3 million Alabamians covered under their plans. BCBS provides a number of plans including Individual & Family, Medicare and Group Health. Surgical Association of Mobile is in-network for most of these plans.

In network providers offer patients a lower out of pocket expense than out of network providers.

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How To Get Bariatric Surgery Covered By Insurance

In certain situations, your health insurance may cover the cost of bariatric surgery. In addition, some states are required to cover bariatric surgery if you have an ACA-compliant health insurance plan through the Marketplace.

However, weight loss surgery is not automatically covered by every policy, and for every person. If you want to get your health insurance provider to cover weight loss surgery, heres what you need to do:

  • Check the details of your health insurance policy: The first step is to review your policy details to see if bariatric surgery is a covered procedure. You also can contact your insurance company and speak with an agent, who can walk you through the fine print of your policy and whats covered.
  • Find a surgeon that is in your network: Next, youll want to choose a surgeon who is in your health plan network. Depending on your plan, a portion of the cost may be paid for if you visit an out-of-network provider. However, because bariatric surgery can be very expensive, seeing an in-network doctor will likely reduce your out-of-pocket cost significantly.
  • How Does The Appeal Process Work

    How long does a Blue Cross approval take??

    Even if your initial request for pre-authorization is not approved, you still have options available. Insurers provide an appeal process that allows you to address each specific reason they have given for denying your request. It is important that you/we reply quickly. Some insurers place limits on the number of appeals you may make, so it is important to be well prepared and that you clearly understand the appeal rules of your specific plan.

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    Must You Go To A Center Of Excellence And In

    The surgery must take place at a Center of Excellence. However, you do not have to use an in-network surgeon. But, the costs will be higher for you if you use an out of network doctor. They will also need to have privileges to perform the weight loss surgery at the accredited Center of Excellence.

    You can contact Anthems customer service at 1-866-293-2892. You can also look on their website www.anthem.com for the email address and contact number.

    What Is Obesity

    Obesity is a complicated illness. Also, the characteristic excess of body fat. Obesity is more than simply an aesthetic issue. As a result of this medical condition, youre more likely to acquire other diseases and health concerns, such as heart disease, type 2 diabetes, high blood pressure, and some types of malignancy. There are several reasons why some people struggle to prevent obesity. Obesity is usually caused by a mix of genetic genes, the environment, and personal food and activity choices. The good news is that even minor weight loss can help or avoid obesity-related health issues. Weight loss can be aided by dietary modifications, increased physical activity, and behavioral changes. Additionally, prescription medicines and weight-loss surgeries are possibilities for managing obesity.

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    How Can A Life

    Payment may be denied because there may be a specific exclusion in a patients policy for obesity surgery or “treatment of obesity.” You can appeal such exclusions by submitting a personal written request to the benefits manager within the insureds place of employment and ask for an exception to policy. Insurance payment could also be denied for lack of medical necessity.” A therapy is deemed to be medically necessary when its needed to treat a serious or life-threatening condition. In the case of morbid obesity, alternative treatments such as dieting, exercise, behavior modification and some medications are considered viable and available. Medical necessity denials usually hinge on the insurance company’s request for some form of documentation, such as physician-supervised dieting or a psychiatric evaluation proving that youve tried unsuccessfully to lose weight by other methods.

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