This is a general outline of Insurance elements
Hurley Bariatric Center recommends contacting your Insurance carrier to verify if Bariatric Surgery or Morbid Obesity is a covered benefit on your policy. Our staff is always available to help with Insurance questions you might have during this process.
Gathering Approval for Bariatric Surgery
Most Insurance companies will require detailed documentation with your efforts to lose weight in the past. To be prepared, please contact your primary care physician to sign a release to obtain the last two years of medical records. These records will be needed to submit to your Insurance Company to prove medical necessity. If your Insurance Company requires a specific supervised diet program and you have not yet started one, please contact the appropriate provider to start your diet program.
Once Hurley Bariatric Center receives all of your test results, records, evaluations, and diet documentation we then create a letter of medical necessity for Bariatric surgery to your insurance company with supporting documentation. Your Insurance Company can take up to 3o days to notify us of their determination. Once we receive the Insurance company determination, we will notify you.
We have listed an assortment of Insurance companies below in alphabetical order that are accepted by Hurley Bariatric Center.
|Insurance Carrier||Medically Supervised Diet||Diet History||Notes|
|Aetna||6 Months OR 3 Months||2 Years||6 Months-nutrition and exercise OR 3 Months-dietician, primary care physician & exercise regimen|
|Blue Care Network||6 Consecutive Months (180 days)||2 Years||BMI ≥50 criteria for diet waived|
|Blue Care Network Advantage||Documented unsuccessful with medical treatment for obesity||2 Years||At least one co-morbidity related to obesity|
|Blue Cross Complete (Medicaid HMO)||6 Months||Current||(Greater than or equal to 6 months)|
|BCBS MI & BCBS Messa||6 Consecutive Months (180 days)||4 Years||BMI ≥50 criteria for diet waived|
|BCBS Out of State||Contact Insurance Plan||2 Years|
|Champ VA||Failed attempts-non surgical medical treatment||2 Years|
|Cigna||3 Consecutive Months||1 Year|
|Cofinity||Contact Insurance Plan|
|Connect Care||3 Months||2 Years|
|Health Alliance Plan (HAP)||6 Months||2 Years||BMI ≥50 criteria for diet waived|
|HealthPlus (HMO and PPO)||6 Months||2 Years||(Unless deemed High Risk with co-morbid diagnosis)|
|Medicaid (Straight)||What efforts have been taken for weight reduction||2 Years||Documented medical diagnosis that may be life threatening as result of obesity|
|Medicare||Documented unsuccessful with medical treatment for obesity||2 Years||At least one co-morbidity related to obesity|
|McLaren Health Plan||6 Consecutive Months. Food & Exercise Journal||Current||Showing a consistent weight loss with no weight gain|
|Molina-Medicaid||12 Consecutive Months||2 Years||Showing a consistent weight loss with no weight gain|
|Priority Health Commercial||6 Months with 12 Months (waived if BMI is > 50)||1 Year||Accept commercial, PPO & Medicare only (Not contracted with Medicaid Priority Hlth)|
|Total Health Care-Medicaid||12 Consecutive Months||1-2 Years||Counseling with Psychiatrist 6-9 months and 6-9 months nutritional counseling|
|Tricare (Standard & Prime)||Prime HMO-6 Months Standard-Not Specific||1 Year||Sleeve is now covered effective 9/2014|
|United Healthcare Commercial||6 Months (not specific with consecutive)||Current||Check Benefits. We do not accept Optum Health through United Health Care|
|United Healthcare Great Lakes-Medicaid||12 Consecutive Months||2 Years||Showing a weight loss and no weight gain|