<>stream Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage. The altered digestive system helps manage weight and fight obesity. Its all about how your doctor and hospital submit your claims to your insurance company. a. (NOTE: Some surgeons offer each procedure for as low as half of the national average). During post-op, your care team will monitor your vital signs and help manage your pain. Important Reminder . San Francisco, CA 94143. Precertification of medical necessity and verification of network provided for bariatric surgery. Many insurance plans require three to six months of medically supervised weight-loss attempts before surgery. Also, this information is not intended to imply that services or treatments described in the information are covered benefits under your plan. surgery Facility fee (e.g., ambulatory surgery center) . Contact your insurance company directly using the phone number on your insurance ID card, Ask for a free insurance check or cost quote, Schedule a phone or in-person consultation (both often free), Have a history of failed weight loss attempts (e.g., failed diets), Thoroughly understand that the procedure is just a tool; long-term success requires significant diet and lifestyle changes, OR a BMI between 30 and 39.9 with a serious obesity-related health problem like diabetes, high blood pressure, sleep apnea, high cholesterol, joint problems, or others, OR a BMI of 30 to 40 with or without health issues for the gastric balloon procedure, How closely you follow your doctors instructions, Archer Medical Savings Account (Archer MSA), Hospital Stay: from outpatient (return home same-day) to 3 days, Your current age, weight, health issues, habits, and lifestyle, What trade-offs you are willing to make. Have a body mass index (BMI) greater than 40 OR have a BMI of 35 or higher plus medical conditions such as high . In some cases, others too can be considered for this surgery. Bariatric Surgery Requirements. A candidate for bariatric surgery must: Be at least 18 years of age. Weight-loss surgery, also known as bariatric surgery, is an operation that makes changes to the digestive system. <>/Filter/FlateDecode/ID[<07D665FAFBB4B2110A00D01B5920FF7F>]/Index[746 34]/Info 745 0 R/Length 109/Prev 282946/Root 747 0 R/Size 780/Type/XRef/W[1 3 1]>>stream Active participation within the last 2 years in a physician-directed weight-management program for 6 or more months without significant gaps (or 3 months if provided through a multidisciplinary bariatric surgery program). endobj For more specific questions regarding bariatric surgery coverage and CIGNA, call 1-800-CIGNA24 (1-800-244-6224). vO To be eligible for weight-loss surgery, you must meet the following requirements: To make an appointment with the UCSF Bariatric Surgery Center, you must also: Before your first appointment with the UCSF Bariatric Surgery Center, please do the following: During the new patient visit, your surgeon will give you a list of tests needed for your evaluation. The program must include monthly documentation of all of the following components: Physical activity (i.e., exercise program), Behavioral interventions to reinforce healthy eating and exercise habits, Consideration of pharmacotherapy with U.S. Food and Drug Administration (FDA) approved weight-loss drugs, Psychological clearance by a mental health professional, Dilatation of the gastric pouch in a member who experienced appropriate weight loss prior to the dilatation. Bariatric and metabolic surgery has helped thousands of people discover life at a healthier weight, resolving many health conditions associated with severe obesity. 400 Parnassus Ave., Second Floor When combined with a comprehensive treatment plan, bariatric surgery may often act as an effective tool to provide you with long term weight-loss and help you increase your quality of health. For further inquiries, contact Blue Cross Blue Shield of Louisiana HMO through their official website https://www.bcbsla.com or call them using the numbers behind your ID card (1-800-495-2583) to get accurate costs on various medical procedures they might be providing cover for based on price and location.Bariatric Revision Log . If you have any concerns about your health, please contact your health care provider's office. Patients usually spend one to two days in the hospital following bariatric surgery. Morbid obesity is further defined as a condition of consistent and . Date of Last Revision: 07/22 . Dr. Jasleen Kukreja and the Life-Saving Gift of Breath, Care, Convenience and Support at New Cancer Facility, 10 Ways to Get the Most Out of Your Doctors Visit, UCSF Health Ranked Among Nation's Top 10 Hospitals. Birthdate *. Cigna does not require a COE designation at this time meaning you can have your surgery wherever your covered surgeon performs procedures. Virtual Providers Members who reside in NY receive no cost primary care when services are performed virtually by ACPNY primary care physician. Morbid obesity reduces life expectancy by 5-20 years. Members are eligible for coverage of a surgical revision of a previous gastric restrictive surgery if it is medically necessary as a result of a complication of the original procedure, such as: Surgical revision is not considered medically necessary for members who have a functional operation (without any evidence of medical abnormality) because of inadequate weight loss. Weight Management. The other types of bariatric surgery are less likely to be covered, although you may be able to get insurance to pay for some of the costs. Find out more. Youll also need to save your medical bills and payment statements as proof. Contact your insurance company to confirm all benefits. Aurora Medical Center - Oshkosh855 N Westhaven Dr.Oshkosh, WI 54904920-907-7420. Patients who qualify for bariatric surgery usually: The minimum bariatric surgery qualifications include: To calculate your BMI, enter your height and weight into the tool, then click the Calculate BMI button. There are two categories of bariatric surgery: restrictive procedures and malabsorptive procedures. Have a body mass index (BMI) over 40, or have . I called and researched and was sent the attached from Emblemhealth. Every participant in the CHPW Bariatric Surgery Program will be referred to Bariatric Care Management for care coordination and support. Carrum Health's partners for bariatrics (such as Scripps Health), follow the National Institutes of Health (NIH) eligibility requirements for bariatric surgery: a body mass index (BMI) of 40 or more, OR. Bariatric surgery (Prior Approval required) Chiropractic care Infertility treatment (Prior Approval required) . Patients may be asked for follow-up visits with a nutritionist, an exercise physiologist . Dietary Guidelines After Bariatric Surgery. 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