blue cross blue shield

[Lap_dancer 8]

I know they have changed the policy in the last 18 months. (that's when I was banded) I know that they claimed they never covered it back then. Now it may be up to the individual policy. ~Mandy

It is in the individual policies. What one company may have purchased could vary from another company. It's like the coconut shells game. Guess which plan the surgery is under!

[piercedqt78 658]

What I was trying to say was in the begining it wasn't even an option for companies to purchase WLS coverage. Now I believe they allow it as an option. I was told that I was the first ever to be covered for the band by Highmark. They didn't even have a negoitated amount in the system. Also fills have to be done under flouro for them to pay, in office fills are not covered at all. ~Mandy

[2bthinagn 3]

I'm trying to appeal to BCBS of Oklahoma for the lap band & am interested in BCBS's coverage of it in other states...anybody out there know???

At a seminar just Tuesday 1-9-07 the insurance guru said BC?BS is starting to cover lapband here. That is the Kansas/Missouri area. A lot more important is the contract the employer has FOR the insurance. But from my understanding...as long as the contract DOESNT have an exclusion for weightloss surgery you can always appeal a denial. DONT GIVE UP!

[bigbaby 4]

What really helped was going through AIGB for weight checks. They did the application for me this time. Also, they called me when they heard the documentation of monthly weight checks needed to be 6 months instead of a year. It helped having them on my side.

Now it is up to me. The hard part. Doing without my favorite drug - food.< /p>

While going through the 6 months of managed weight loss, how much weight did you loose? I don't want to loose too much and be denied and I don't want to not lose and they say that I'm not serious and be denied---UGH--WHAT TO DO????

[airwayman 2]

I'm trying to appeal to BCBS of Oklahoma for the lap band & am interested in BCBS's coverage of it in other states...anybody out there know???

A few days ago I called BCBS in my home state of NC. It went something like this:

Ring....Ring.

Them: BCBS of NC may I hep you?

Me: Yes ma'am. Just wanted to check on weight loss surgery coverage. Do you provide coverage for the adjustable gastric band?

Them: Hmmmm......A what...adjustable...(trailed off)...jest a minute, lemme check with my super.

Me: Read the entire paper, sing all verses of 98 bottles of Beer on the Wall, fill out income tax for next 4 years.

Them: Hun, you still there:

Me: ZZZZZZZZZZZZ

Them: HEY!!

Me: Yeah, yeah I'm still here!! Whad you find out?

Them: Is that a roax and Y? Or a duo-something-or-another switch?"

Me: No ma'am, a gastric band, maybe it's called Adjustable Gastric Band, a AGB, gastric banding or a trade name like LAP-Band, perhaps?"

Them: Yeah, here it is....an adjustable gastric band?

Me: YES!! That's it!! That's it!!

Them: Nah, we don't cover it. Says here it's "investigational?"

[piercedqt78 658]

Fight that, call inamed and get the packet from them. They have a packet just for the denial. I talked to Don Mills and he sent it right out to me. That is a beatable denial, it was FDA approved in 2001. ~Mandy

[Lap_dancer 8]

Hello All:

At this point I consider myself the guru to the guru of BCBS's policy for gastric surgery. I will share everything I know.

(background, I have been at this since September)

an exclusion in the policy reads like this:

Blue Care for Large Groups Member Handbook:

Section 15: Covered Services Introduction

"Covered Services

Expenses for the health care services listed below will be covered under the Group Plan only if the services are:

4. not specifically limited or exluded..."

Section 22: Exclusions and Limitations

"Exclusions

49. Weight control services including any service to lose, gain, or

maintain weight, including without limitation: any weight control/loss

program; appetite suppressants; dietary regimens; food or food supplements; excercise programs, equipment or memberships; or surgical procedures."

..........................................SNIP

That is what my policy reads like. I'm going to my employer to the medical insurance committee and appealing for a purchase of a rider to specifically include gastric surgery ( Lap Band ). That meeting for me is January 31st. My position is I pay for insurance, I have a condition my physician has deemed medically necessary, the insurance I pay for does not cover it because my company purchased that exclusion in the contract.

Now on to the other questions and comments. About that "investigational" argument and that it is NOT covered because it is still investigational. That is incorrect. You want to call them back and speak to a supervisor and tell them you were told it was excluded because it is investigation and referr them to this memo from BCBS Corporate which changes it out of investigative to approved.

This is the Press Release regarding the procedure from BCBS in November of 2006, it reads:

http://www.bcbs.com/betterknowledge/tec/press/

The following Assessments and Special Reports were acted on at the November 2, 2006, Blue Cross and Blue Shield Association Medical Advisory Panel (MAP) meeting:

Laparoscopic Adjustable Gastric Banding for Morbid Obesity

The MAP concluded that laparoscopic adjustable gastric banding for morbid obesity meets the TEC criteria, when performed in appropriately selected patients, by surgeons who are adequately trained and experienced in the specific techniques used, and in institutions that support a comprehensive bariatric surgery program, including long-term monitoring and follow-up post-surgery.

Articles from BCBS about gastric surgery:

http://www.bluecares.com/about/search.jsp?query=gastric

Find your BCBS company for your state where you can go to the search engine and look up GASTRIC for hits on information for their policy.

http://www.bcbs.com/coverage/find/plan/

Hey Airwayman.....might want to PRINT this and fax it to your insurance company. It's BCBS of NC's policy for medical code 43770 Adjustable Gastric Banding!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! ( you do have to meet the criteria which is there to read)

https://www.bcbsnc.com/services/medical-policy/pdf/surgery_for_morbid_obesity.pdf

[Lap_dancer 8]

Because I am bored and want to help as many people as possible today so they do not feel my frustration.

A) Do not assume that customer service knows your coverage. They are misinformed at times.

Getting mad at your insurance company's customer service representative is about as effective as cutting off your nose to spite your face.

C) Always know more than them.

D) Have a notepad availabe and jot down the person's name as they say it, the time and a summary of your conversation.

E) Have a plan B, C, D...

F) I have not come across anyone who did not require the procedure to first be deemed Medically Necessary by supporting documentation.

...........................................................................................

Who does what and always check what KIND of insurance you have..PPO? HMO? because that will determine coverage.

Alabama Blue Cross and Blue Shield

https://www.bcbsal.org/health/important/bariatric.cfm#10

Blue of California

https://www.blueshieldca.com/hw/articles/hw_article.jsp?articleId=HWHW252819

Connecticut, Anthem BCBS

http://www.anthem.com/medicalpolicies/noapplication/f4/s10/t2/pw_034084.pdf

Delaware

http://www.anthem.com/medicalpolicies/noapplication/f4/s10/t2/pw_034084.pdf

This site covers multiple states.

PDF] Medical Policy - SURG.00024 - Surgery for Clinically Severe ...

... Policy Statement Medically Necessary: Gastric bypass with a Roux Y procedure up

to 150 cm, laparoscopic adjustable gastric banding (the Lap-Band ® ...

www.anthem.com/medicalpolicies/noapplication/f4/s10/t2/pw_034084.pdf - 2006-11-11 - Text Version

[Lap_dancer 8]

A few days ago I called BCBS in my home state of NC. It went something like this:

Them: Nah, we don't cover it. Says here it's "investigational?"

http://mcgs.bcbsfl.com/

Note the timeline on this:

02-40000-10

Original Effective Date: 10/15/99

Reviewed: 04/27/06

Revised: 05/15/06

Next Review: 04/26/07 Subject: Surgery for Clinically Severe Obesity (Bariatric Surgery; Gastric Bypass Surgery)

DESCRIPTION:

Clinically severe obesity is a result of persistent and uncontrollable weight gain that constitutes a present or potential threat to life. For purposes of this medical coverage guideline, clinically severe obesity is defined as a body mass index (BMI) of 35 kg/m2 or greater. See the height and weight tables for Men and Woman, BMI tables (100-195, 200-295, 300-400, and formula for calculating a BMI.

Several surgical (bariatric) procedures are used for the treatment of clinically severe obesity. These procedures can be categorized as follows:

• <LI class=bulletedList-1>Malabsorptive procedures - alteration of the intestinal absorption limiting nutrients available to the body OR
  
• Gastric restrictive procedures - reduction in the capacity of the stomach thereby limiting the amount of food ingested.

Gastric surgical procedures for the treatment of clinically severe obesity include:

• <LI class=bulletedList-1>gastric bypass where approximately 90% of the stomach is bypassed and reattached to the proximal jejunum OR
  
• gastric stapling, vertically banded gastric partition, or vertically banded gastroplasty where a proximal pouch of 30-60 ml and a one centimeter outlet are created by a row of vertical staples and a horizontally placed reinforcing band.

WHEN SERVICES ARE COVERED:

Effective January 1 2005, weight loss surgery is not covered for most contracts. Please refer to the individual member’s contract benefit language.

NOTE: The primary care physician must provide a letter with facts supporting medical necessity, for review by the Medical Director.

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:

• <LI class=bulletedList-1>meets the above definition of clinically severe obesity, <LI class=bulletedList-1>has been severely obese for at least five (5) years, <LI class=bulletedList-1>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 <LI class=bulletedList-1>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).

The following procedures may be considered medically necessary when the above criteria has been met:

Vertical-Banded Gastroplasty (CPT code 43842)

Vertical-banded gastroplasty was formerly one of the most common gastric restrictive procedures performed in this country but has more recently declined in popularity. In this procedure, the stomach is segmented along its vertical axis. To create a durable reinforced and rate-limiting stoma at the distal end of the pouch, a plug of stomach is removed, and a propylene collar is placed through this hole and then stapled to itself. Because the normal flow of food is preserved, metabolic complications are uncommon. Complications include esophageal reflux, dilation, or obstruction of the stoma, with the latter 2 requiring reoperation. Dilation of the stoma is a common reason for weight regain. Vertical-banded gastroplasty may be performed using an open or laparoscopic approach.

Roux-en-Y Gastric Bypass (CPT code 43644, 43846)

Gastric bypass may be performed with either an open or laparoscopic technique. The original gastric bypass surgeries were based on the observation that post-gastrectomy patients tended to lose weight. The current procedure involves a horizontal or vertical partition of the stomach in association with a Roux-en-Y procedure (i.e., a gastrojejunal anastomosis). Thus, the flow of food bypasses the duodenum and proximal small bowel. The procedure may also be associated with an unpleasant “dumping syndrome,” in which a large osmotic load delivered directly to the jejunum from the stomach produces abdominal pain OR vomiting. The dumping syndrome may further reduce intake, particularly in “sweets eaters”. Operative complications include leakage and marginal ulceration at the anastomotic site. Because the normal flow of food is disrupted, there are more metabolic complications compared to other gastric restrictive procedures. These complications may include Iron deficiency anemia, Vitamin B-12 deficiency, and hypocalcemia, all of which can be corrected by oral supplementation. Another concern is the ability to evaluate the “blind” bypassed portion of the stomach.

Long Limb Gastric Bypass (i.e., more than 100 cm) (CPT code 43847)

Recently, variations of gastric bypass procedures have been described, consisting primarily of long limb Roux-en-Y procedures, which vary in the length of the alimentary and common limbs. For example, the stomach may be divided with a long segment of the jejunum (instead of ileum) anastomosed to the proximal gastric stump, creating the alimentary limb. The remaining pancreaticobiliary limb, consisting of stomach remnant, duodenum, and length of proximal jejunum is then anastomosed to the ileum, creating a common limb of variable length in which the ingested food mixes with the pancreaticobiliary juices. While the long alimentary limb permits absorption of most nutrients, the short common limb primarily limits absorption of fats. The stomach may be bypassed in a variety of ways (i.e., either by resection or stapling along the horizontal or vertical axis). Unlike the traditional gastric bypass, which is essentially a gastric restrictive procedure, these very long limb Roux-en-Y gastric bypasses combine gastric restriction with some element of malabsorptive procedure, depending on the location of the anastomoses.

NOTE: Coverage of long limb Roux-en-Y procedures is limited to 150 cm. Adjustable gastric banding (i.e., Lap-Band Adjustable Gastric Banding System) (CPT code 43770, 43771, 43772, 43773, 43774)

Adjustable gastric banding involves placing a gastric band around the exterior of the stomach. The band is attached to a reservoir that is implanted subcutaneously in the rectus sheath. Injecting the reservoir with saline will alter the diameter of the gastric band; therefore, the rate- limiting stoma in the stomach can be progressively narrowed to induce greater weight loss, or expanded if complications develop. Because the stomach is not entered, the surgery and any revisions, if necessary, are relatively simple. Complications include slippage of the external band or band erosion through the gastric wall. Adjustable gastric banding has been widely used in Europe. Currently, the U.S. Food and Drug Administration (FDA) has approved one such device for marketing in the United States, Lap-Band (BioEnterics, Carpentiera, CA). The labeled indications for this device are as follows:

"The Lap-Band system is indicated for use in weight reduction for severely obese patients with a body mass index (BMI) of at least 40 or a BMI of at least 35 with one or more severe comorbid conditions, or those who are 100 lbs or more over their estimated ideal weight according to the 1983 Metropolitan Life Insurance Tables (use the midpoint for medium frame). It is indicated for use only in severely obese adult patients who have failed more conservative weight-reduction alternatives, such as supervised diet, exercise and behavior modification programs. Patients who elect to have this surgery must make the commitment to accept significant changes in their eating habits for the rest of their lives."

Biliopancreatic Bypass with Duodenal Switch (43845)

The duodenal switch procedure is essentially a variant of the biliopancreatic bypass. However, instead of performing a distal gastrectomy, a “sleeve” gastrectomy is performed along the vertical axis of the stomach, preserving the pylorus and initial segment of the duodenum, which is then anastomosed to a segment of the ileum, similar to the above procedure, to create the alimentary limb. Preservation of the pyloric sphincter is designed to be more physiologic. The sleeve gastrectomy decreases the volume of the stomach and also decreases the parietal cell mass, with the intent of decreasing the incidence of ulcers at the duodenoileal anastomosis. However, the basic principle of the procedure is similar to that of the biliopancreatic bypass (i.e., producing selective malabsorption by limiting the food digestion and absorption to a short common ileal segment).

WHEN SERVICES ARE NOT COVERED:

Surgery for clinically severe obesity is not covered when these services are excluded from the member’s contract benefits.

Studies are needed to determine the long-term health outcomes of the following procedures, therefore the procedures listed below are considered investigational when performed for the treatment of clinically severe obesity:

Biliopancreatic Bypass Procedure (i.e., the Scopinaro procedure) (CPT code 43847)

Biliopancreatic bypass (BPB) procedure, developed and used extensively in Italy, was designed to address some of the drawbacks of the original intestinal bypass procedures that have been abandoned due to unacceptable metabolic complications. Many of the complications were thought to be related to bacterial overgrowth and toxin production in the blind, bypassed segment. In contrast, BPB consists of a subtotal gastrectomy and diversion of the biliopancreatic juices into the distal ileum by a long Roux-en-Y procedure.

This procedure consists of the following components:

• <LI class=bulletedList-1>A distal gastrectomy functions to induce a temporary early

satiety OR the dumping syndrome in the early postoperative period, both of which limit food intake <LI class=bulletedList-1>A 200-cm long “alimentary tract” consists of 200 cm of ileum connecting the stomach to a common distal segment <LI class=bulletedList-1>A 300- to 400-cm “biliary tract,” which connects the duodenum, jejunum, and remaining ileum to the common distal segment <LI class=bulletedList-1>A 50- to 100-cm “common tract,” where food from the alimentary tract mixes with biliopancreatic juices from the biliary tract. Food digestion and absorption, particularly of fats and starches, are therefore limited to this small segment of bowel (i.e., creating a selective malabsorption). The length of the common segment will influence the degree of malabsorption
Because of the high incidence of cholelithiasis associated with the procedure, patients typically undergo an associated cholecystectomy. Many potential metabolic complications are related to biliopancreatic bypass, including most prominently iron deficiency anemia, Protein malnutrition, hypocalcemia, and bone demineralization. Protein malnutrition may require treatment with total parenteral nutrition (TPN). In addition, there have been several case reports of liver failure resulting in death or liver transplant.

Mini-Gastric Bypass (no specific CPT code)

Recently, a variant of the gastric bypass, called the “mini-gastric bypass” has been popularized. Using a laparoscopic approach, the stomach is segmented, similar to a traditional gastric bypass, but instead of creating a Roux-en-Y anastomosis, the jejunum is anastomosed directly to the stomach, similar to a Billroth II procedure. This unique aspect of this procedure is not based on its laparoscopic approach, but rather the type of anastomosis used.

NOTE: CPT code 43846 does not accurately describe the mini-gastric bypass, since this CPT code explicitly describes a Roux-en-Y gastroenterostomy, which is not used in the mini-gastric bypass.

The following procedures reported as gastric bypass or gastroplasty are also considered investigational due to the lack of clinical studies to support effects on health outcomes:

• <LI class=bulletedList-1>

jejunoileal bypass <LI class=bulletedList-1>gastric wrapping
Garren-Edwards gastric bubble.

BILLING/CODING INFORMATION:

CPT Coding:

43644

Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (Roux limb 150 cm or less)

43645

Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and small intestine reconstruction to limit absorption (investigational)

43770

Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric band (gastric band and subcutaneous port components)

43771

Laparoscopy, surgical, gastric restrictive procedure; revision of adjustable gastric band component only

43772

Laparoscopy, surgical, gastric restrictive procedure; removal and replacement of adjustable gastric band component only

43773

Laparoscopy, surgical, gastric restrictive procedure; removal and replacement of adjustable gastric band component only

43774

Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric band and subcutaneous port components

43842

Gastric restrictive procedure, without gastric bypass, for morbid obesity; vertical-banded gastroplasty

43843

Gastric restrictive procedure, without gastric bypass, for morbid obesity; other than vertical-banded gastroplasty (investigational)

43845

Gastric restrictive procedure with partial gastrectomy, pylorus-preserving duodenoileostomy and ileoileostomy (50 to 100 cm common channel) to limit absorption (biliopancreatic diversion with duodenal switch)

43846

Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb (150 cm or less) Roux-en-Y gastroenterostomy (may be done laparoscopically)

43847

Gastric restrictive procedure, with gastric bypass for morbid obesity; with small intestine reconstruction to limit absorption (may be done laparoscopically)

There is no specific CPT or HCPCS code to report mini gastric bypass. A laparoscopic approach is used with the mini-gastric bypass. The stomach is segmented similar to a traditional gastric bypass; the jejunum is anastomosed directly to the stomach, similar to a Billroth II procedure. The mini gastric bypass is not based on its laparoscopic approach, but rather the type of anastomosis used. HCPCS Coding

S2083

Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline

ICD-9 Diagnoses Codes That Support Medical Necessity:

278.01

Morbid obesity

REIMBURSEMENT INFORMATION:

Bariatric surgical procedures are limited to individuals 18 years and older and are reimbursed based on the procedure performed and not the surgical technique used (e.g., microsurgical, laser, laparoscopic). PROGRAM EXCEPTIONS:

Federal Employee Program (FEP): Follow FEP guidelines.

State Account Organization (SAO): Follow SAO guidelines. DEFINITIONS:

Biliopancreatic bypass: gastric restriction rerouting bile and pancreatic juice to the distal ileum.

Garren-Edwards gastric bubble: a free-floating intragastric device made of elastomeric plastic is placed in the stomach via a gastroscope, used for reducing stomach capacity.

Gastric wrapping: the stomach is folded over on itself and a full stomach wrap, i.e. polypropylene mesh, is applied to limit gastric volume.

Gastric banding: a synthetic band rather than staples is used to divide the stomach into a small upper pouch and a lower portion).

Gastric bubble: see definition of Garren-Edwards gastric bubble.

Jejunoileal bypass: shunts food from the jejunum into the ileum, bypassing the small intestine.

Morbid obesity: defined as a body mass index (BMI) of 40 kg/m2 or greater.

Satiety: the quality or state of being fed or gratified to or beyond capacity. RELATED GUIDELINES:

Gastric Bypass Revision, 02-40000-11 OTHER:

Other index terms for gastric surgery: Adjustable gastric banding

Bariatric surgery

Gastric bypass surgery

Lap-Band System

Mini gastric bypass

Billroth II

Long limb gastric bypass

Roux-en-Y

Scopinaro

Vertical banding

REFERENCES:

1. <LI value=1>All-plan survey (Blue Cross Blue Shield plans) <LI value=2>American Academy of Medicine CPT Coding (current edition) <LI value=3>Blue Cross Blue Shield Association TEC Evaluation (12/88), 2003 <LI value=4>Blue Cross Blue Shield Association TEC Special Report: The relationship between weight loss and changes in morbidity following bariatric surgery for morbid obesity. BCBSA TEC Assessment Program, 2003; 18:1-25 <LI value=5>Blue Cross Blue Shield Association-Surgery for Morbid Obesity (7.01.47), 12/14/05 <LI value=6>DeMaria, E J, Sugerman, H J, Meador, J G, et al. High Failure Rate After Laparoscopic Adjustable Silicone Gastric Banding for Treatment of Morbid Obesity. Annals of Surgery 2001:233:809-818 <LI value=7>First Coast Service Options (FCSO) Medical Policy - surgical Management of Morbid Obesity, LCD #L14600 (01/01/06) <LI value=8>Guidance for Treatment of Adult Obesity, American Obesity Assoc., 1998 <LI value=9>Hayes Medical Technology Directory - Laproscopic Bariatric Surgery - us.lapa0008.2005 (11/03; Update report 12/05) <LI value=10>Hayes Medical Technology Directory - Obesity Management, Surgical Approaches OBES0802.03 (10/99; updated 07/27/02; updated 04/04/03) <LI value=11>InterQual Care Planning Criteria: General Surgery; Weight Loss Surgery GS-23 (2003) <LI value=12>National Institutes of Health Consensus Development Conference on Gastrointestinal Surgery for Severe Obesity Statement (March 25-27, 1991) <LI value=13>Rutledge MD, Robert. “The Mini-Gastric Bypass: Experience with the First 1,274 Cases”; Obesity Surgery 2001; 11:276-280 <LI value=14>St. Anthony’s ICD-9-CM code book (current edition)
   
2. U.S. Food and Administration (FDA) Talk Paper, FDA Approves Implanted Stomach Band To Treat Severe Obesity, T01-26, 06/05/01

COMMITTEE APPROVAL:

This Medical Coverage Guideline (MCG) was approved by the BCBSF Medical Policy & Coverage Committee on 04/27/06. GUIDELINE UPDATE INFORMATION:

10/15/99

Medical Coverage Guideline developed.

09/15/01

Various revisions.

01/01/02

Coding changes.

10/15/02

Annual review. Added Roux-enY anastomosis or vertical-banded as covered services. Added biliopancreatic bypass with duodenal switch and very long limb gastric bypass procedure (e.g., greater than 100 cm) as non-covered services.

05/15/03

Revised to clarify coding of the various procedures; criteria revised and is consistent with Inter-Qual criteria.

09/15/03

Coverage criteria for psychological testing/counseling revised.

10/15/03

Reversed investigational status for CPT code 43847 and provided coverage criteria for long-limb Roux-en-Y procedures up to 150 cm.

01/01/04

Annual HCPCS coding update.

04/01/04

2nd Quarter HCPCS coding update; added S2082 and S2083.

07/15/04

Scheduled review; no changes.

01/01/05

HCPCS coding update. Added 43644, 43645, 43845, S2082, and S2083. Revised descriptor for 43846, and deleted S2085.

05/15/05

Unscheduled review of the non-covered statement for laparoscopic adjustable gastric banding (Lap-Band); coverage statement unchanged.

01/01/06

Annual HCPCS coding update (added 43770-43774; deleted S2082).

04/15/06

Scheduled review; removed investigational statement for laparoscopic adjustable gastric banding and biliopancreatic diversion with duodenal switch; updated coding, index terms, and references.

05/15/06

Scheduled review; removed investigational statement for laparoscopic adjustable gastric banding and biliopancreatic diversion with duodenal switch; updated coding, index terms, and references; added age limitation of 18 years and older.

Private Property of Blue Cross and Blue Shield of Florida.

This medical coverage guideline is Copyright 2006, Blue Cross and Blue Shield of Florida (BCBSF). All Rights Reserved. You may not copy or use this document or disclose its contents without the express written permission of BCBSF. The medical codes referenced in this document may be proprietary and owned by others. BCBSF makes no claim of ownership of such codes. Our use of such codes in this document is for explanation and guidance and should not be construed as a license for their use by you. Before utilizing the codes, please be sure that to the extent required, you have secured any appropriate licenses for such use. Current Procedural Terminology (CPT) is copyright 2006 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. CPT® is a trademark of the American Medical Association.

[airwayman 2]

Wow!! You are something else, Lap Dancer. I read the NC policy on morbid obesity (you sent me the link) it DOES NOT cover ABG but I also read the link you sent where it they removed the investigational wording. I plan to call those thugs on Monday. No, I won't get mad, I just plan to have my pit bull face on. I'll keep you posted. JB

[airwayman 2]

Hey Airwayman.....might want to PRINT this and fax it to your insurance company. It's BCBS of NC's policy for medical code 43770 Adjustable Gastric Banding!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! ( you do have to meet the criteria which is there to read)

https://www.bcbsnc.com/services/medi...id_obesity.pdf

Hi, thanks for all your efforts!! However, in reading the link above, on page 6 (they're not numbered) under Procedures NOT covered, Item D is Gastric Banding.

[airwayman 2]

Hey Airwayman.....might want to PRINT this and fax it to your insurance company. It's BCBS of NC's policy for medical code 43770 Adjustable Gastric Banding!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! ( you do have to meet the criteria which is there to read)

I read the whole link, I didn't see that medical code anywhere. Where did you find it?? Thanks!

[Lap_dancer 8]

Hey Airwayman.....might want to PRINT this and fax it to your insurance company. It's BCBS of NC's policy for medical code 43770 Adjustable Gastric Banding!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! ( you do have to meet the criteria which is there to read)

I read the whole link, I didn't see that medical code anywhere. Where did you find it?? Thanks!

Same link, page 4 of 13 (yes they are numbered but not on the pages, on the PDF file link at the bottom)

POLICY

BCBSNC will provide coverage for morbid obesity when it is determined to be medically necessary because the medical criteria and guidelines shown below are met. See also Policy Guidelines.

...............................................

Hey Airwayman.....might want to PRINT this and fax it to your insurance company. It's BCBS of NC's policy for medical code 43770 Adjustable Gastric Banding!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! ( you do have to meet the criteria which is there to read)

https://www.bcbsnc.com/services/medi...id_obesity.pdf

[airwayman 2]

Hey Airwayman.....might want to PRINT this and fax it to your insurance company. It's BCBS of NC's policy for medical code 43770 Adjustable Gastric Banding!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! ( you do have to meet the criteria which is there to read)

https://www.bcbsnc.com/services/medi...id_obesity.pdf

Where did you find this code? Is it significant?

[Lap_dancer 8]

Hey Airwayman.....might want to PRINT this and fax it to your insurance company. It's BCBS of NC's policy for medical code 43770 Adjustable Gastric Banding!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! ( you do have to meet the criteria which is there to read)

https://www.bcbsnc.com/services/medi...id_obesity.pdf

Where did you find this code? Is it significant?

See the web address? The first part of it is BCBSNC.com that is Blue Cross and Blue Shield of North Caroline. The remainder is services and their obesity memo.

The medical codes are what are standard use in the field of medicine for a diagnosis and a code for medical purposes to process the paper work.

It's on the web. No big surprise. Just go to BCBSNC's website and log in with your member number or as a guest. Your searches should be one word "gastric" "bariatric" or "obesity".