Blue Cross Blue Shield of New Mexico
  Blue Distinction Centers For Bariatric Surgery
 
Home
Health Risk Assessment
Weight Loss Guide
Patient Education Tools
For Your Health Program
EMMI Bariatric Surgery
Decision Support Tool

Medical Policy on Surgery
Blue Distinction Centers
Bariatric Surgery FAQs
 

Why we have Blue Distinction Centers
The growing obesity epidemic is a serious health concern. Requests for Bariatric Surgery are on the rise throughout the country. While many surgeons and hospitals are willing to perform this operation, their experience varies greatly.

The Blue Distinction Centers for Bariatric Surgery has identified the hospitals that met a broad range of criteria, focusing on experience and surgical outcomes. Use of such centers has typically improved health outcomes and financial performance by lowering complications.

Types of Blue Distinction Centers and who may use them
If you are a Blue Cross and Blue Shield of New Mexico member whose health insurance plan includes coverage for bariatric surgery, you may take advantage of the Blue Distinction Centers for Bariatric Surgery.

If you are seeking care in a state other than New Mexico, you may take advantage of the national Blue Distinction Centers for Bariatric Surgery. Some of these centers are located in nearby states and may be convenient. Click here to view the current list of Blue Distinction Centers for Bariatric Surgery.

If you are not a member of Blue Cross and Blue Shield of Illinois, the information on this Web site may not apply to you - Please contact your own health plan.

How the Blue Distinction centers were formed
Selection criteria for the Blue Distinction Centers for Bariatric Surgery were developed with the objectives of improving overall patient outcomes and delivering better value. The criteria used to designate the Centers were established through collaboration with expert physician panels and national organizations.

Criteria for Blue Distinction Centers for Bariatric Surgery evaluate:

  • Full-service, accredited inpatient hospital facility;
  • Program must be performing bariatric surgery for the most recent 18-24-month period and must perform a required volume of bariatric surgical cases;
  • Experience and credentialing of the bariatric surgical team;
  • Ongoing quality management and improvement programs;
  • Appropriate equipment and staffing; and
  • Patient care and follow-up care including evaluation of bariatric surgery complication and mortality rates.

Member participation
Although members whose benefit plan includes coverage for bariatric surgery will be advised of the Blue Distinction Centers, the members will remain free to choose other contracted facilities without penalty. The member must complete a medical weight management program and all other criteria in the medical policy on Surgery for Morbid Obesity must be satisfied before bariatric surgery can be considered. When using a Blue Distinction Center for Bariatric Surgery members should confirm that the surgeon is part of the contracting network by calling customer service. Members will not receive in network benefits for the services of surgeons or other providers who are not in the contracted provider network of the member's health plan.

The HMO program follows a different procedure than that described above. If you are an HMO member, consult with your Primary Care Physician regarding the most appropriate treatment for your condition.

 

These features are not available to all members. Contact Blue Cross and Blue Shield of Illinois Member Services for more information. You can access obesity information and the Health Risk Assessment via Blue Access® for Members.

These services do not apply to HMO members. As with other medical conditions, HMO members are encouraged to coordinate their care through their Primary Care Provider.

[an error occurred while processing this directive]