INSURANCE UPDATE

[Jnpxo2 24]

He Hey guys !my insurance said they cover all the bariatic services my PA asked me to ask them. The requirements I believe they said there was no required supervised diet however I do have some history with phertamine. My bmi is right at 40.4. I’m gonna ass a screen shot of the blue home plan for bariatic ! I think it should be an easy process as far as what they’re asking for. I hope to have my surgery by June fingers crossed.

Anyone have experience with novant ? In Nc

Pasted what the picture has in case visibility is hard. 

A thorough preoperative evaluation for bariatric surgery must include all of the following:

1. Evaluation of the patient's understanding of the procedure to be performed, including the procedure's risks and benefits, length of stay in the hospital, behavioral changes required prior to

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An Independent Licensee of the Blue Cross and Blue Shield Association

Bariatric Surgery

and after the surgical procedure (including dietary and exercise requirements), follow up requirements with the performing surgeon, and anticipated psychological changes.

2.

3.

Evaluation of the patient's family/caregivers support and understanding of the information in #1.

Within 12 months prior to surgery, a thorough nutritional evaluation by a physician, registered dietician, or other licensed professional experienced in the issues of bariatric surgery, who has had a meaningful conversation with the individual regarding the dietary and lifestyle changes required to ensure a successful outcome over time. Nutritional assessment must follow American Society for Metabolic and Bariatric Surgery (ASMBS) guidelines. Pre-operative assessment must document that the patient has a good understanding of the diet and nutritional changes that are associated with bariatric surgery and has the capacity to comply with these changes. Per the ASMBS guidelines, "

*..it is essential to determine any preexisting nutritional deficiencies, develop

appropriate dietary interventions for correction, and create a plan for postoperative dietary intake that will enhance the likelihood of success. Not only should the practitioner review the standard assessment components (i.e., medical co-morbidities, weight history, laboratory values, and nutritional intake), it is also important to evaluate other issues that could affect nutrient status, including readiness for change, realistic goal setting, general nutrition knowledge, as well as behavioral, cultural, psychosocial, and economic issues." 2019 guidelines for perioperative nutrition, metabolic and nonsurgical support are available at:

4.

https://journals.aace.com/doi/pdf/10.4158/GL-2019-0406

Within 12 months prior to surgery, a formal psychosocial-behavioral evaluation performed by a qualified behavioral health professional (i.e., licensed in a recognized behavioral health discipline, such as psychology, social work, psychiatry, psychiatric nursing, etc., with specialized knowledge and training relevant to obesity, eating disorders, and/or bariatric procedures), which assesses environmental, familial, and behavioral factors, as well as risk for suicide. Any patient considered for a bariatric procedure with a known or suspected psychiatric illness, or substance abuse or dependence, should undergo a formal mental health evaluation before the procedure. 2019 guidelines for perioperative nutrition, metabolic and nonsurgical support are available at https://journals.aace.com/doi/pdf/10.4158/GL-2019-0406

5. Appropriate medical work up may include a chest x-ray, upper gastrointestinal series, endoscopy, appropriate pre-op labs and ECG. A complete physical examination by the attending surgeon and an assessment of thyroid levels is required. If the patient has comorbid conditions (e.g. diabetes or

6.

cardiovascular disease) the patient must be capable of undergoing the procedure.

Anesthesia clearance for surgery.

The first five criteria must be met before seeking prior plan approval for adults and adolescents; the sixth must be met prior to surgery. Surgical procedures must be performed at a facility capable of providing gastrointestinal and biliary surgery (preferably JCAHO accredited), AND that has equipment and staff capable of managing a morbidly obese patient (appropriate instruments, beds, lifts, monitoring equipment) AND that can manage short and long term complications of bariatric surgery.