GenJones
Well-Known Member
Here's what I dug out of my 88-page EOC:
47. Charges for the following services for the treatment of Morbid Obesity: examinations/Physician visits; laboratory and x- ray and other diagnostic testing; Inpatient facility services; outpatient facility services; Durable Medical Equipment; bariatric surgery; and nutritional counseling. Benefits will be limited to one (1) course of treatment per Covered Person per Lifetime.
Benefits will be payable for bariatric surgery when the following conditions are met:
1. The patient is age eighteen (18) or older; and
2. The patient’s Physician has provided documentation within the last two (2) years in one (1) Physician-directed weight management program for a minimum of six (6) months without significant gaps. The weight-management program must include monthly documentation of all of the following components: (a) vital signs, including weight; (b) current dietary program; (c) physical activity (i.e. exercise program); (d) behavioral interventions to reinforce healthy eating and exercise habits; and (e) consideration of pharmacotherapy and U.S. Food and Drug Administration (FDA)-approved weight-loss drugs, if appropriate. Diet programs/plans alone, such as Weight Watchers and similar plans are not considered Physician-directed weight-management programs and do not meet this requirement. Similarly, Physician-directed programs consisting exclusively of pharmacological management are not sufficient to meet this requirement; and
3. The patient has had a recent psychological evaluation in which they are evaluated to rule out Psychiatric Disorders (e.g. schizophrenia, major depression, chemical dependency) that interfere with adherence to a new lifestyle and are cleared for surgery.
My insurance plan is Cigna Open Access Plus.
47. Charges for the following services for the treatment of Morbid Obesity: examinations/Physician visits; laboratory and x- ray and other diagnostic testing; Inpatient facility services; outpatient facility services; Durable Medical Equipment; bariatric surgery; and nutritional counseling. Benefits will be limited to one (1) course of treatment per Covered Person per Lifetime.
Benefits will be payable for bariatric surgery when the following conditions are met:
1. The patient is age eighteen (18) or older; and
2. The patient’s Physician has provided documentation within the last two (2) years in one (1) Physician-directed weight management program for a minimum of six (6) months without significant gaps. The weight-management program must include monthly documentation of all of the following components: (a) vital signs, including weight; (b) current dietary program; (c) physical activity (i.e. exercise program); (d) behavioral interventions to reinforce healthy eating and exercise habits; and (e) consideration of pharmacotherapy and U.S. Food and Drug Administration (FDA)-approved weight-loss drugs, if appropriate. Diet programs/plans alone, such as Weight Watchers and similar plans are not considered Physician-directed weight-management programs and do not meet this requirement. Similarly, Physician-directed programs consisting exclusively of pharmacological management are not sufficient to meet this requirement; and
3. The patient has had a recent psychological evaluation in which they are evaluated to rule out Psychiatric Disorders (e.g. schizophrenia, major depression, chemical dependency) that interfere with adherence to a new lifestyle and are cleared for surgery.
My insurance plan is Cigna Open Access Plus.
