FEP BCBS
It's in the 2011 handbook. In fact, it's a new requirement for 2011!
• Benefits for the surgical treatment of morbid obesity, performed on an inpatient or outpatient basis, are subject to the following pre-surgical requirements:
− Diagnosis of morbid obesity (as defined on page 52) for a period of 2 years prior to surgery
− Participation in a medically supervised weight loss program, including nutritional counseling, for at least 3 months prior to the date of surgery. (Note: Benefits are not available for commercial weight loss programs; see page 34 for our coverage of nutritional counseling services.)
− Pre-operative nutritional assessment and nutritional counseling about pre- and post-operative nutrition, eating, and exercise
− Evidence that attempts at weight loss in the 1 year period prior to surgery have been ineffective
− Psychological assessment of the member’s ability to understand and adhere to the pre- and post-operative program, performed by a psychiatrist, clinical psychologist, psychiatric social worker, or psychiatric nurse (see page 85 for our payment levels for mental health services)
− Patient has not smoked in the 6 months prior to surgery
− Patient has not been treated for substance abuse for 1 year prior to surgery
• Benefits for the surgical treatment of morbid obesity, performed on an inpatient or outpatient basis, are subject to the following pre-surgical requirements:
− Diagnosis of morbid obesity (as defined on page 52) for a period of 2 years prior to surgery
− Participation in a medically supervised weight loss program, including nutritional counseling, for at least 3 months prior to the date of surgery. (Note: Benefits are not available for commercial weight loss programs; see page 34 for our coverage of nutritional counseling services.)
− Pre-operative nutritional assessment and nutritional counseling about pre- and post-operative nutrition, eating, and exercise
− Evidence that attempts at weight loss in the 1 year period prior to surgery have been ineffective
− Psychological assessment of the member’s ability to understand and adhere to the pre- and post-operative program, performed by a psychiatrist, clinical psychologist, psychiatric social worker, or psychiatric nurse (see page 85 for our payment levels for mental health services)
− Patient has not smoked in the 6 months prior to surgery
− Patient has not been treated for substance abuse for 1 year prior to surgery
Most Active
Recent Topics
