Bariatric Surgery Update for Plan Members
The State Health Plan provides coverage for bariatric surgery, or surgery for obesity. On and after July 1, 2010, the Plan will only cover bariatric surgeries performed at Blue Distinction Centers (BDCs). The BDCs are facilities that have demonstrated expertise in meeting national standards for quality outcomes, as certified by the Blue Cross and Blue Shield Association (BCBS).
Through the Blue Cross Blue Shield of North Carolina (BCBSNC) Preferred Provider Organization (PPO) arrangement, the State Health Plan adopted the network of BCBS Association Blue Distinction Centers nationwide for the provision of the bariatric surgery benefit, as allowed under Session Law 2009-16. The goals of this benefit change are to ensure that members receive the highest quality and most cost-effective bariatric surgery intervention. The BCBS Blue Distinction Centers designation process provides the Plan with an objective assessment of a facility's ability to deliver high quality services to members.
State Health Plan members have access to 12 in-network BDC facilities in North Carolina and many others nationally. The State Health Plan is hopeful that additional facilities, including those currently in the review process, will also be successful in obtaining the designation. However, the Plan will only approve bariatric surgeries at hospitals that have fully qualified for the BDC designation. On and after July 1, 2010, the Plan will not pay for bariatric surgery and related services obtained at a hospital that does not have the BCBS Association BDC designation.
For State Health Plan members who are currently in the care of a physician and are considering bariatric surgery, it is very important to verify as soon as possible that the surgery will be performed at a Blue Distinction Center for obesity surgery. Members should visit the "Find a Doctor" page on the State Health Plan website, and select "Obesity Surgery Blue Distinction Center," under Specialty.