Dear Prospective Patient:

At a Premier Bariatric Associates Information Session, you will learn about obesity surgery procedures which we perform. You will also learn about the risks and potential complications of obesity surgery. We provide you with this information to help you decide which surgery would be best for you, should you choose to have obesity surgery.

A letter of medical necessity that includes your diagnosis, treatment, height, weight and BMI* is required from your primary care physician on his/her letterhead. All patients also require a psychiatric evaluation. Please contact your insurance company and check for their specific requirements and for exclusions in your contract. You may find a toll-free number on your insurance card in order to do so.

• Aetna

  • Documentation from your doctor showing a 6-month physician-supervised diet program that includes exercise and behavior modification.

  • BPD/DS** surgery is not a covered service.

   

• Anthem

  • Pre-surgical dietary assessment with a registered dietician.

  • BPD/DS** surgery is a covered service only if your BMI* is 50 or greater.

    • Highmark BC/BS (Anthem)

      • Also requires a 6-month physician supervised diet

    • BC/BS of Michigan (Anthem

      • Also requires a 12-month diet history.

• Cigna

  • Pre-surgical dietary consultation with a registered dietician.

  • BPD/DS** surgery is not a covered service.

   

• Medical Mutual

  • Pre-surgical dietary assessment with a registered dietician.

  • Documentation from your doctor showing a 5-year weight history

  • Documentation from your doctor showing a 6-month physician-supervised diet program.

   

• Medicare

  • Must have a co-morbid condition (i.e. hypertension, diabetes mellitus, asthma, COPD).

  • BPD/DS** surgery is not a covered service as stipulated by Ohio's Medicare provider

   

• United HealthCare

  • UHC -- (other) may be a covered service depending on your plan.

  • UHC of Ohio -- obesity surgery is not a covered service.

  • UHC federal employees -- obesity surgery is a covered benefit under your plan.

   

• Great West

  • 2-year physician-supervised detailed diet history

   

• Ohio Health Choice

  • Nutritional evaluation

  • Physician-supervised diet.

   

• United Medical Resources

  • Must be employed for 3 years

  • Only pays at 50%.

    *Body Mass Index
   **Biliopancreatic Diversion/Duodenal Switch

   revised 05/2005