Surgery to relieve the condition of advanced obesity
For members whose health insurance plan includes coverage for bariatric surgery, Blue Cross and Blue Shield of New Mexico has recognized Blue Distinction Centers for Bariatric Surgery to aid in the review of the procedure, and members have access to hospitals in our network that perform the surgery. However, members can still choose to have surgery performed in a facility other than the Blue Distinction Centers for Bariatric Surgery.
The growing obesity epidemic is a serious health concern and continues to be widely publicized. 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 hospitals that met a broad range of criteria, focusing on experience and surgical outcomes.
The selection process began with a rigorous, 27-page Request for Information (RFI) developed in close collaboration with the Blue Cross and Blue Shield Association (BCBSA). The RFI sought detailed information about qualifications and experience from each hospital along with their surgical success rates and complications during the past several years. A review committee, consisting of the Quality Management Medical Directors, conducted a name-blinded analysis of the RFI results. Based on defined clinical criteria the Centers for Bariatric Surgery were selected.
No. A member who has the bariatric surgery benefit must still meet all of the clinical eligibility criteria in our Medical Policy on Surgery for Morbid Obesity .
Studies show the highest success rate occurs in centers that have the most experience. When selecting the Blue Distinction Centers for Bariatric Surgery, the success rate for each facility and all complications for the past several years were examined, as well as the qualifications and experience of the hospital.
Although members whose health insurance plan includes coverage for bariatric surgery will be advised of the Blue Distinction Centers, the members will remain free to choose other facilities without penalty. When using a Blue Distinction Center, 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. Of course, use of a Blue Distinction Center does not assure a successful outcome.
A good way is to contact the hospital, using the phone number we provide. Many hospitals also have Web sites dedicated to their bariatric surgery programs. You will want to schedule an appointment with one of the bariatric surgeons in the hospital program. Important: Check that the surgeon is currently participating in the network that serves your particular insurance plan. When visiting the surgeon’s office, request that the other physicians involved in your case are also in your network.
