Hi, I am wondering if anyone has had any luck getting the ESG procedure covered by insurance? Even better if you have experience with CareFirst BlueChoice. I have called them to ask about coverage and no one has an answer since it is not considered surgery. I also have not been able to find out what codes may be used for billing, as they said they could look into it that way.

Thanks!

So I do not have that insurance, but what I could find was that they do cover a variety of options here is a link.

https://secure.compliance360.com/Common/ViewUploadedFile.aspx?PD=PbRt%2bA78MS7DkR7t3eswzx4PmIfqMh5Gvr16ARj2%2bYR%2fbM3Br19IKOL7BmMQvCh%2bObdTwt55hbmBERTk8pGaqPegW8FFx95O2WGDad%2fP32wtK%2fLy3eAuPemfjKVE4PNzPcJl4Diuz13mj3pVztiXT1jOk1QXXnxshbN53Oyornctpycy8rUdp6PO01yKHuAyjToezDSmtv7QFcCDCBNlPkza0BIOxIDU2F3sAcfC9iWbTygtlPuPosN%2b0KsA3MMUlStY4KrcPnrna%2fEhFWHpkpUaKhgyCBBOFWIbN6dlv9A%3d

On 9/5/2023 at 9:15 PM, New To This23 said:

So I do not have that insurance, but what I could find was that they do cover a variety of options here is a link.

https://secure.compliance360.com/Common/ViewUploadedFile.aspx?PD=PbRt%2bA78MS7DkR7t3eswzx4PmIfqMh5Gvr16ARj2%2bYR%2fbM3Br19IKOL7BmMQvCh%2bObdTwt55hbmBERTk8pGaqPegW8FFx95O2WGDad%2fP32wtK%2fLy3eAuPemfjKVE4PNzPcJl4Diuz13mj3pVztiXT1jOk1QXXnxshbN53Oyornctpycy8rUdp6PO01yKHuAyjToezDSmtv7QFcCDCBNlPkza0BIOxIDU2F3sAcfC9iWbTygtlPuPosN%2b0KsA3MMUlStY4KrcPnrna%2fEhFWHpkpUaKhgyCBBOFWIbN6dlv9A%3d

Hi! Thank you, I cannot get that link to work, can you share more info?

From what I remember they cover all obesity-related surgeries, but I do not remember ESG being on the list specifically. I also think that members in Virginia had fewer hoops to jump through than members in DC and Marylin. This is from the CareFirst site.

Blue Distinction® Specialty Care

The hospital you select can have a direct impact on the care you receive and your procedure results, but finding the right facility can sometimes be a challenge. The Blue Distinction Specialty Care recognition program identifies health care facilities with proven expertise in delivering specialty care. There are two designations:

• Blue Distinction Centers - Health care facilities recognized for expertise in delivering specialty care.
• Blue Distinction Centers+ - Health care facilities recognized for expertise and cost efficiency in delivering specialty care.

Blue Distinction focuses on high-volume, high-risk and high-cost areas of specialty care, including:

• Bariatric Surgery centers provide a full range of bariatric surgical care services, including inpatient care, post-operative care, follow-up and patient education.

Edited September 18, 20232 yr by New To This23
Adding info

On 9/18/2023 at 8:00 AM, New To This23 said:

From what I remember they cover all obesity-related surgeries, but I do not remember ESG being on the list specifically. I also think that members in Virginia had fewer hoops to jump through than members in DC and Marylin. This is from the CareFirst site.

Blue Distinction® Specialty Care

The hospital you select can have a direct impact on the care you receive and your procedure results, but finding the right facility can sometimes be a challenge. The Blue Distinction Specialty Care recognition program identifies health care facilities with proven expertise in delivering specialty care. There are two designations:

• Blue Distinction Centers - Health care facilities recognized for expertise in delivering specialty care.
• Blue Distinction Centers+ - Health care facilities recognized for expertise and cost efficiency in delivering specialty care.

Blue Distinction focuses on high-volume, high-risk and high-cost areas of specialty care, including:

• Bariatric Surgery centers provide a full range of bariatric surgical care services, including inpatient care, post-operative care, follow-up and patient education.

Thank you!

I’ve run into similar issues with ambiguous insurance code stuff, especially when it comes to newer or non-traditional procedures like ESG. It’s super frustrating calling and getting different answers each time. I had to push a lot for coverage on something once, and only got traction when the billing office from the provider contacted the insurer directly with suggested codes.

If you're planning more procedures or looking into broader health coverage in the future, especially for your family, I found this info on https://premierpmi.co.uk/health-insurance/health-insurance-for-a-family-of-4/ pretty helpful when we were comparing options. It gave me a clearer picture of what to expect.

Edited May 1, 20251 yr by PorkChopExpress