blue cross blue shield

[Lap_dancer 8]

Your insurance carrier may request the name of the surgery and the CPT/ICD-9 codes. Insurance companies use the following codes to identify the type of procedure or surgery:

• Lap Gastric Banding: 43770
  
• Lap Gastric Bypass: 43644
  
• Diagnosis Code (ICD-9) for Morbid Obesity: 278.01
  
• 
  

[TracyinKS 7]

So how goes YOUR battle LapDancer????

[airwayman 2]

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".

Yeah, did all that yesterday...got my subscriber no. etc. and entered BCBSNC's site. I looked all over the site.....used the Search, etc. and nary a word about approving gastric banding. I found the Corporate Medical Policy on Surgery for Morbid Obesity (you had already sent me the link) and I read it from stem to stern hoping it had been amended..nope. I could NOT find the press release from the TEC wherein the MAP concluded that laparoscopic gastric banding met their criteria. I have a private number for one of the BCBSNC's representatives...a lady I have had good luck with in the past on unrelated issues. I gathered all my stuff and called to discuss. All I got was her voice mail but I left a detailed message on this specific issue. I asked her to call or email when she found out anything. I'll keep you posted. Again, many thanks for your help. JB

[kwhenrykerr 0]

Try to keep a log of your calls, who, what, when, and send e-mails when you can.

Do Not Give Up

[blj5362 0]

I have BCBS Anthem I live in WV and they covered 90% of the surgery and the fills except for the office co-pay.

[airwayman 2]

I have BCBS Anthem I live in WV and they covered 90% of the surgery and the fills except for the office co-pay.

And this was for Lap-Band surgery?? What is BCBS "Anthem?"

[blj5362 0]

Airwayman, I think Anthem is just a type of insurance that BCBS offers. My company tells the insurance company what they want to be covered and not covered and WLS is definely on the list.

[airwayman 2]

Airwayman, I think Anthem is just a type of insurance that BCBS offers. My company tells the insurance company what they want to be covered and not covered and WLS is definely on the list.

WLS is definitely on my BCBS policy, too....only under items not covered is d.) gastric banding.

[blj5362 0]

We are very fortunate......

[Lap_dancer 8]

So how goes YOUR battle LapDancer????

Tracy! I was thinking of you today! Great to see you posting here. How is your case doing?

I have a meeting on Jan. 31st with my employer's medical insurance committee. I am appealing for the purchase of a rider on my policy for the surgery. Apparently this is not an odd request as I was told they often get requests for items. I am hopeful about this. I have all my notes in order and am actually excited about the meetings. My plan C if this doesn't work is to self pay and fly to Mexico for Dr. Ortiz.< /p>

[TracyinKS 7]

That IS VERY HOPEFUL NEWS LD!!!!!!!!!

For me ... just waiting on the psych and nutrition letters to be faxed to doc and then for them to fax to bcbs sc, for the claim number........

Keep us posted on YOUR progress!

[Lap_dancer 8]

That IS VERY HOPEFUL NEWS LD!!!!!!!!!

For me ... just waiting on the psych and nutrition letters to be faxed to doc and then for them to fax to bcbs sc, for the claim number........

Keep us posted on YOUR progress!

Will do! and good thoughts going your way for a succesful outcome.

[formykids 0]

I have bcbs here in Maine and they covered my lap band and fills after I appealed the initial denial. I have not had any insurance problems... thank god.

[staceylynn 0]

I'm in WA and am covered by Federal BC/BS which began covering LapBand as of 2007. My Dr.'s office called to double check on the coverage and was told they do cover it but the will not pre-authorize it. In other words, you get the surgery and you take your chances!

I also have coverage under TriCare Prime (hubby is retired military) and they should pick up what ever is left over so I'm going thru with it but it seems like BC/BS is trying to scare us away from the surgery!

[Lap_dancer 8]

From BCBS Association (corporate)

Laparoscopic Gastric Bypass Surgery for Morbid Obesity

Assessment Program

Volume 20, No. 15

February 2006

Executive Summary

Background

Bariatric surgery leads to substantial amounts of weight loss in morbidly obese patients, and evidence exists that this weight loss leads to net improvements in health outcomes. Among different surgical procedures, gastric bypass offers the most favorable benefit/risk ratio. Gastric bypass was originally developed as an open procedure, but can also be performed as a laparoscopic procedure.

Objective

To review the available evidence on whether laparoscopic gastric bypass (LGBY) results in similar improvements in health outcomes as does open gastric bypass (GBY).

Literature Review

Literature Review

The MEDLINE database was searched electronically for articles for the period of 1980 through May 2005, supplemented by hand search of bibliographies and search of Cochrane database.

Selection Criteria

Comparative studies of open vs. laparoscopic GBY that included at least 25 patients per treatment arm, that reported on the outcomes of weight loss and/or adverse events, and that had at least 1 year of follow-up (for weight loss outcomes) were included in the Assessment. Single-arm studies with the same characteristics were included if the minimum number of enrolled patients was 100 or more.

Results

Weight loss at 1 year was very similar for laparoscopic and open procedures. The data on longer term weight loss were less rigorous, but it appears that long-term weight loss is similar as well between the two approaches. Summary estimates were made for perioperative and long-term complications. The estimated mortality rate was low for both procedures, but somewhat lower for laparoscopic surgery (0.3% vs. 1.1%). The laparoscopic procedures had a higher rate of postoperative anastomotic leaks than open procedures (3.7% vs. 1.9%) and a somewhat higher rate of bleeding (4.1% vs. 2.4%). On the other hand, open surgery had higher rates of cardiopulmonary complications (2.6% vs. 1.0%) and wound infections (11.0% vs. 4.7%).

Long-term adverse event rates were reported by a smaller number of studies, lending less precision to these data. For the laparoscopic group, the rates of reoperation (9.9%) and anastomotic problems (8.0%) may be higher than for the open group (6.0% and 2.0%, respectively), while the rate of incisional hernia is higher for the open group (9.0% vs. 0%).

The evidence did not allow a rigorous examination of the impact of programmatic elements or hospital setting on outcomes. Documentation of a thorough preoperative assessment was used as a proxy for a comprehensive, multidisciplinary program, but sensitivity analysis on this variable did not reveal any clear patterns.

Conclusion

The evidence is sufficient to conclude that weight loss is similar between the two procedures. In a previous TEC Assessment performed in 2003, evidence on the comparative rates of adverse events was not sufficient to form conclusions. A number of new studies available since the previous report provide additional evidence on adverse events, thus addressing the primary deficiency in the evidence reviewed at that time.

The profile of adverse events differs between the two approaches, with each having its advantages and disadvantages. LGBY offers a less-invasive procedure that is associated with decreased hospital stay and earlier return to usual activities. The mortality may be lower with the laparoscopic approach, although both procedures have mortality rates less than 1%. Postoperative wound infections and incisional hernias are also less common with LGBY. On the other hand, anastomotic problems, GI bleeding, and bowel obstruction appear to be higher with the laparoscopic approach, but not markedly higher. Given these data, it is not possible to say that one procedure is superior to the other, and overall the benefit/risk ratio for these two approaches appears to be more similar than different.

Concern remains about the generalizability of published results, which largely represent high-volume, academic programs, to other settings. While evidence exists to support a positive correlation between volume and outcomes for bariatric surgery in general, the evidence is not sufficient to determine the impact of other programmatic elements and/or hospital setting on outcomes of LGBY.

Based on the available evidence, the Blue Cross and Blue Shield Medical Advisory Panel made the following judgments about whether laparoscopic gastric bypass meets the Blue Cross and Blue Shield Association Technology Evaluation Center (TEC) criteria.

1. The technology must have final approval from the appropriate governmental regulatory bodies.

The intervention under consideration is a surgical procedure and is not subject to U.S. food and Drug Administration (FDA) regulations.

2. The scientific evidence must permit conclusions concerning the effect of the technology on health outcomes.

The available evidence is sufficient to form conclusions on the benefits and risks of laparoscopic gastric bypass compared with open gastric bypass. Weight loss at 1 year is similar for laparoscopic gastric bypass compared to open gastric bypass. The profile of short-term adverse events differs between the two approaches, with each having its advantages and disadvantages. Given these data, the overall outcomes of laparoscopic gastric bypass appear to be similar to open gastric bypass.

3. The technology must improve the net health outcome.

The evidence is sufficient to conclude that laparoscopic gastric bypass improves the net health outcome. Data from non-randomized comparative trials are sufficient to establish that health outcomes are improved following bariatric surgery in general. Among available bariatric surgical procedures, gastric bypass with Roux-en-Y anastomosis appears to have the most favorable benefit/risk ratio. The current Assessment establishes that the overall benefit/risk ratio of laparoscopic gastric bypass is similar to that of open gastric bypass. Therefore, it can be determined that laparoscopic gastric bypass, as well as open gastric bypass, improves the net health outcome.

4. The technology must be as beneficial as any established alternatives.

The main established alternative to laparoscopic gastric bypass is open gastric bypass, and this Assessment concludes that the benefits and risks of laparoscopic gastric bypass compared with open gastric bypass are similar. Therefore, laparoscopic gastric bypass is as beneficial as established alternatives.

5. The improvement must be attainable outside the investigational settings.

The improvement in health outcomes for laparoscopic gastric bypass can be attained outside the investigational setting, if the training of surgeons and the programmatic elements are similar to programs in the published literature, and if performed at a hospital with sufficient surgical volume. However, there may be considerable variation in capabilities and resources among different bariatric surgery programs. To address this concern, Blue Cross and Blue Shield Association and the American College of Surgeons have developed criteria for credentialing and tracking outcomes from bariatric surgery programs.

Based on the above, laparoscopic gastric bypass 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.

FULL STUDY

Laparoscopic Gastric Bypass Surgery for Morbid Obesity

Full studies are in PDF format. You will need Adobe Acrobat Reader to view all studies.

Download Adobe Acrobat Reader here.

http://www.bcbs.com/betterknowledge/tec/vols/20/20_15.html

Source found at above website.