Help - I need Bariatric wls Insurance codes
Hi All,
I was under the impression that BCBS of Florida no longer covered WLS.
My exclusion book says obesity treatment must be medically necessary.
I want to call Ins provider to ask about WLS and I thought knowing the codes will be helpful. Wish me luck.
FYI-I have BlueCare an hmo plan for large groups by health Options Inc.
I am so excited because my only alternative is to go through Aetna.
Thanks
AnnaMarie
I found the Ins code on BCBS online.
The code for Lap RNY is 43644. Here is what I found out online
Certain surgical procedures performed for the treatment of clinically severe obesity may be considered medically necessary when ALL of the following conditions are met:
The member:
meets the above definition of clinically severe obesity,
has been severely obese for at least five (5) years,
has attempted a physician supervised (by the primary care physician) non-surgical management weight loss program (e.g., diet, exercise, drugs) for six (6) consecutive months
has received psychological or psychiatric evaluation with counseling as needed, prior to surgical intervention;
does not have a medically treatable cause for the obesity, (e.g., thyroid or other endocrine disorder).
AnnaMarie
Hi,
I had BCBS health options and was told last year that they would not cover WLS in any condition as of 1/1/05 so i switched to aetna, and they kind of require the same things at BCBS a diet for at least 3 months which I did, proof of obesity for at least 5 years and some other minor stuff but if you have alot of cormids than I believe you wouldn't even have to do that. But I got approved by aenta withing 2 hours of my Dr faxing all the paper work. So good luck with BCBS
Jennifer
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