Posted in BCBS Empire NY

BCBS: 32BJ Health Fund Plan- Bariatric Surgery and Joint Replacement Surgery

If you are a surgeon that performs bariatric surgery or joint replacement surgery and see 32BJ Health Fund (BCBS) patients in your office, then this important update is for you! The change will take affect for all surgeries done on DOS 01/01/2022 and thereafter.

32BJ Health Fund has partnered with Hospitals in NY, New Jersey, Connecticut, Massachusetts, Pennsylvania, and Florida to implement a Centers of Excellence (COE) Program for Bariatric and Joint Replacement surgeries.

1.Identifying 32BJ Health Fund patients:

32BJ Health Fund patients are easily identified by the prefix “ETRBJ.”, on their insurance card.

2.Coverage for Bariatric Surgery and Joint Replacement Surgery:

Patients will only be covered if the bariatric surgery and/or joint replacement surgery is performed in one of these COE centers. There will be a $0 copay with a 30 day follow up, after surgery.

32BJ Health Fund patients are NOT COVERED for bariatric and joint replacement surgeries performed by a non-COE provider or at a non-COE hospital.

3.Locating a participating COE provider or COE Hospital:

In order to locate a participating COE provider and a COE Hospital, members need to contact: Plan participants may call 32BJ Member Services at (800) 551-3225.

Providers may call Empire Provider Services at (800) 676-2583.

In addition, 32BJ Health fund patients who live within 50 MILES OF COE Hospital, HAVE to perform their surgery performed by a COE provider at a COE hospital.

(More than 90% of 32BJ members live within 50 miles of a COE hospital.)

More information for Providers:

Any provider looking for more information—particularly anyone currently caring for 32BJ plan participants who may be candidates for bariatric or joint replacement surgery—should call Empire Provider Services at 1-800-676-2583.

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My name is Kate Patskovska, CPB. I am an Independent Medical Biller CPB (AAPC) and an owner of KR2 Medical Billing. KR2 Medical Billing is a full service Consulting/Medical Billing Business that is dedicated to educating, consulting, and overall improving the "financial health" of your medical practice.

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