Bariatric Surgery FAQs for Employees in the GRMC Group Health Plan

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1 Bariatric Surgery FAQs fr Emplyees in the GRMC Grup Health Plan Gergia Regents Medical Center and Gergia Regents Medical Assciates emplyees and eligible dependents wh are in the GRMC Grup Health Plan (Select PPO r Chice HDHP) may have the ability t receive bariatric surgery perfrmed exclusively at the Gergia Regents Center fr Obesity and Metablism. Bariatric surgery is nt cvered if yu have the Base PPO Plan, and, is nt a cvered benefit utside f the Gergia Regents Center fr Obesity and Metablism. 1. What are the requirements that ne has t meet t be cnsidered fr having the surgery perfrmed? UMR requires the fllwing established precertificatin criteria belw. Dcumentatin fr review must include actual clinical ntes. Patient s current height, weight, and Bdy Mass Index (BMI). BMI abve 40kg/m 2 If BMI is between 35kg/m 2 and 39kg/m 2 medical recrd dcumentatin f clinically serius medical cnditins, if any, that have been exacerbated by mrbid besity (examples: hypertensin, diabetes, sleep apnea, fatty liver disease, heart disease, chrnic bstructive pulmnary disease, plycycstic varian disease) Dcumentatin f participatin in and cmpliance with a physician-supervised nn-surgical weight lss prgram fr at least 4 cnsecutive mnths in duratin within the past 3 years. This includes a lw r very lw calrie diet, supervised exercise, behavir mdificatin, and supprt, with pssible medicatin. Dcumentatin f a preperative medical cnsultatin and apprval (including thyrid panel with TSH). Preperative psychiatric cnsultatin and apprval. Dcumentatin that the surgical prgram is experienced in besity surgery, characterized by surgens experienced with bariatric surgical prcedures and a multidisciplinary apprach, including: Medical cnsultatin Psychiatric cnsultatin Nutritinal cunseling Exercise cunseling Supprt grup meetings 2. Des the Gergia Regents Center fr Obesity and Metablism have additinal criteria that must be met? Additinal requirements, alng with the basic insurance requirements, include: Age greater than 18 years Meet NIH and ther natinal guidelines fr besity surgery. Dcumented supervised weight lss attempt with failure. Medically cleared and apprved by the multidisciplinary bariatric team members, including required evaluatin by the bariatrician, psychlgist, dietitian and surgen. Mentally and emtinally prepared and mtivated N substance abuse r unhealthy lifestyle habits (drug abuse, alchl abuse and tbacc use) Have gd understanding f prcedure and lifestyle changes required fr lng-term success

2 Have realistic expectatins regarding utcme after surgery Have intact supprt structure t be successful fllwing bariatric surgery (wrk, family, friends, wh are engaged in prcess with the patient) Insurance apprval fr evaluatin and surgery 3. Des the Gergia Regents Center fr Obesity and Metablism have additinal criteria that must be met because it is a new bariatric prgram? The Gergia Regents Center fr Obesity and Metablism meets natinal medical guidelines fr besity surgery fr an ASMBS Cmprehensive bariatric prgram, therefre n additinal criteria are necessary ther than items listed belw. In additin t the basic requirements fr apprval, the prgram als requires: Weight lss requirement prir t surgery (based n BMI as per the prgram requirements) $3,000 c-pay fr Select PPO health plan members; 30% after meeting deductible fr Chice HDHP health plan members Three years f cntinuus GRMC health plan membership prir t the emplyees initial evaluatin/assessment. 4. Hw d we define Mrbid Obesity? Mrbid Obesity means a Bdy Mass Index (BMI) that is greater than r equal t 40 kg/m 2, r a BMI greater than r equal t 35kg/m 2 with serius medical cnditin(s) exacerbated by, r caused by besity. Mrbid Obesity fr a Cvered Persn wh is less than 19 years f age means a BMI that falls abve the 95th percentile n the grwth chart. 5. Hw many years f being a GRMC health plan member are required in rder t be eligible fr the bariatric surgery benefit? The benefit will be available after the emplyee has met three years f cntinuus GRMC health plan membership. The member must meet the 3 year requirement prir t entering the evaluatin/assessment stage. 6. Hw sn can I start the weight lss prgram? This benefit will begin n August 1, Yu must have met the three (3) year GRMC grup health plan membership eligibility requirement prir t the beginning f yur evaluatin/assessment befre yu are eligible fr the prcedure. 7. Prir t and after my bariatric surgery, what is my respnsibility fr cpays, cinsurance, etc. under my GRMC grup health plan? There are tw cmpnents t this benefit nce yu have met the precertificatin requirements and are eligible fr the benefit. The first is the "Evaluatin/Assessment" cmpnent which is designed t prvide educatin fr yu and infrmatin fr the Gergia Regents Center fr Obesity and Metablism surgen. This will result in a

3 decisin by yu and yur surgen abut the apprpriateness f a surgical weight lss prcedure fr yu. Yu are respnsible fr the cpayment r c-insurance fr each appintment assciated with the services during the Evaluatin/Assessment perid. Subsequently, when it is determined that yu are an apprpriate candidate fr a bariatric surgical prcedure and yu decide t prceed with btaining the service, there is a "package" f services included in the definitin f "bariatric surgery" which include the surgery itself, and the additinal attentin f the surgens during the defined pst-perative perid. Select PPO health plan members will be respnsible fr a $3,000 cpay. Chice HDHP health plan members will be respnsible fr a 30% cinsurance after deductible is met. 8. When d I pay the surgery cpayment r cinsurance? Payment will be requested nce yu meet the precertificatin requirements and yur surgery has been apprved by UMR, the Third Party Administratr fr the GRMC grup health plan. The $3,000 facility cpay fr Select PPO health plan members r 30% cinsurance pst deductible fr Chice health plan member, must be paid in full at least tw weeks prir t the surgery date r the surgery will be cancelled. 9. What if I cannt pay the surgery cpayment r cinsurance in ne payment? We encurage the set up f a Flexible Spending Accunt (FSA) t assist yu in preparing fr the surgery cpay r cinsurance if yu are in the Select PPO health plan, r, yu may add dllars t yur Health Savings Accunt if yu are in the Chice HDHP. 10. May I have my surgery perfrmed by the physician f my chice and the facility f my chice? N. The surgery is cvered nly if perfrmed by the Gergia Regents Medical Center fr Obesity and Metablism surgens and if yu meet the requirements f the prgram. The Gergia Regents Medical Center fr Obesity and Metablism must als request precertificatin frm UMR. 11. Are my dependents eligible fr bariatric surgery assuming I have met my three years f cntinuus GRMC grup health plan membership prir t the evaluatin/assessment? Yes, assuming that the dependent is at least 18 years f age, als has three years f cntinuus GRMC grup health plan membership prir t the evaluatin/assessment, and meets all ther eligibility requirements. 12. Des the bariatric surgery benefit allw me t have anther bariatric surgery if the first prcedure des nt wrk? Yes, if yur failure t lse weight after surgery des nt reflect lack f cmpliance r fllwup with the Gergia Regents Medical Center fr Obesity and Metablism. Prir t any additinal bariatric surgery, yu will fall under the same evaluatin, apprval prcess and related csts. Yur surgen must dcument the need and/r reasn fr failure f initial bariatric surgery and indicatin fr subsequent bariatric surgery prcedure.

4 13. If I had bariatric surgery under anther plicy prir t my becming a member f the GRMC grup health plan, and I m in need f revisinal surgery, am I permitted t have an additinal bariatric surgery as a GRMC grup health plan member prvided I meet all eligibility requirements? Certain revisinal surgeries will be cnsidered and apprved based n the specific clinical situatin that applies. Revisins fr medically necessary reasns such as debilitating nn-healing ulcer disease r chrnic bstructins will be given higher pririty. The plan will nt allw fr revisinal peratins fr the fllwing indicatins: a) Weight regain after a primary bariatric prcedure withut anatmic abnrmality (e.g. gastrgastric fistula, recurrent marginal ulcer, stricture, excessive gastric puch size). b) Weight regain after a primary bariatric prcedure with an anatmic abnrmality, but wh d nt cmplete and fully cmply with apprpriate preperative nutritinal, exercise, and psychlgical recmmendatins. 14. Are their types f bariatric surgeries nt cvered by the GRMC grup health plan? Yes. Adjustable gastric band placement is nt cvered by the plan. This prcedure has nw been shwn t be less efficacius, t carry a higher lng term cmplicatin rate, and t be less cst-effective. 15. Are any cmplicatins due t a previus surgery fr mrbid besity cvered under anther carrier's plicy r self-pay (prir t me becming a GRMC grup health plan member) cvered by my GRMC grup health plan? The plan will prvide apprpriate care fr patients with previusly placed bands including band adjustments with r withut flurscpy, revisin f prt if nt able t be accessed, and band remval. The plan will als prvide apprpriate care fr patients wh need a band remval with cnversin t gastric bypass r sleeve gastrectmy, hwever, nly if the patient cntinues t meet NIH criteria fr these prcedures. (Prfessinal fee will exclude band remval) 16. After I have my surgery, will the GRMC grup health plan cver surgery t remve any excess skin? Nt if purely csmetic in nature. Any surgery r prcedures fr remval f excess skin will nt be cvered by the plan unless medically necessary. 17. If I had surgery at anther medical facility and want t have fllw-up care at GRMC, will this be cvered by the GRMC grup health plan? If the prir surgery was perfrmed at anther facility and if yu have 3 years f cntinuus GRMC grup health plan membership prir t yur evaluatin/assessment) at the Gergia Regents Center fr Obesity and Metablism, fllw-up care is available. Prgram fee s/deductibles and/r c-insurances are based n the plan yu are in at the time f care. 18. Wh d I call if I have a questin abut my bariatric surgery benefits? Fr evaluatin/assessment, educatin sessin(s) and general insurance inquiries, yu may call the Gergia Regents Bariatric Prgram Crdinatr at r at weightlssprgram@gru.edu. Fr general GRMC grup health plan questins, please cntact the GRMC Benefits ffice at

5 19. Once I enter the evaluatin/assessment perid, will I autmatically be eligible fr the bariatric surgery? N, the decisin as t whether yu will receive bariatric surgery as a cvered benefit depends n whether: Yu meet all the pre-evaluatin and evaluatin/assessment requirements yu and yur Gergia Regents Center fr Obesity and Metablism team agree that yu shuld prceed with the surgery yu are apprved fr the surgery by UMR 20. When is my prcess certified? Once UMR has received the precertificatin request frm the GRMC Bariatric Prgram Crdinatr, they will render a decisin, prvided they have all the necessary infrmatin. If apprved, yu will receive a written cnfirmatin f the apprval frm UMR and the Bariatric Prgram Crdinatr will cntact yu. 21. If I am denied, what is my appeal prcess? If yur request fr bariatric surgery is denied, UMR will ntify yu in writing and prvide the reasn fr the denial. The written ntificatin will include detailed instructins n hw t appeal the decisin.

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