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 program 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.
Members of Blue Cross and Blue Shield of Illinois may take advantage of the Blue Distinction Centers for Bariatric Surgery. Members using the Blue Distinction Centers or Blue Centers have to meet medical necessity criteria for the surgery. See the section Medical Policy – Bariatric Surgery.
Those who are not members of Blue Cross and Blue Shield of Illinois should contact their own health plan (the information on this website may not apply to them).
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.
BCBSIL member participation is voluntary. Members whose benefit plan includes coverage for bariatric surgery will be advised of the Blue Distinction Centers for Bariatric Surgery; however, depending upon the member's benefit design, the member may be able to choose other contracted facilities without penalty. The member must complete a medical weight management program and satisfy all other criteria in the medical policy regarding Surgery for Morbid Obesity 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. HMO members need to consult with their Primary Care Physician regarding the most appropriate treatment for their condition.
Check the Blue Cross and Blue Shield Association's list of Blue Distinction Centers for Bariatric Surgery . Before making an appointment, memers need to call BCBSIL Customer Service to verify plan coverage for services, and to confirm the provider's network participation status as a Blue Distinction Center.