Insurance

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.

Obtaining Approval

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.

Insurance List

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