Looks like our new insurance plan this year will be HAP. They do cover WLS, but I don't yet know if OUR plan includes it. Has anyone had HAP cover this, and if so, what hoops did you have to jump though to get it done? Thanks!

I am the Lap-Band Program Director at our office and HAP will cover the surgery only if it is done at a HAP facility. Our hospital takes HAP patients; but HAP will only pay for bariatric surgery at their hospital. Any other surgery is usually ok.

Nancy, thank you! It looks like we're not changing until April 1st (nobody at this company really has a clue what's going on, including the people supposedly in charge of this). Maybe you can answer another question for me: If my primary Dr. is affiliated with a HAP hospital where the lap band procedure is not performed, will HAP pay for me to go to a DIFFERENT HAP hospital where it is? Thanks! :welldone:

OH! And do you know offhand what HAP's requirements are? Don't go digging for them unless you already know, I'll find out in a few months anyway. Thanks!

yes i would like to know also.

On 10/16/2008 at 6:23 PM, sweettea25 said:

yes i would like to know also.

Hope this helps. I have Hap as well and have just begun this process.

COVERAGE CRITERIA

1. Bariatric surgery is covered for HAP/AHL Members (other than Medicare Advantage) when all of the following criteria are met:
   1. Member must be at least 18 years of age
   2. Member's medical record must show documentation of one of the following:
      1. BMI (Body Mass Index) 35 - 39.9 with at least one comorbidity requiring active treatment beyond lifestyle modification including but not limited to:
         1. Cardiovascular disease
         2. Diabetes mellitus
         3. Sleep apnea
         4. Hypertension
         5. Hyperlipidemia
         6. Pulmonary hypertension
      2. BMI greater than or equal to 40 with or without co-morbid conditions
   3. Members with a BMI below 50 must demonstrate evidence of active participation within the last two years in any weight-management program, whether covered by HAP or not, for a minimum of three months without significant gaps. The weight-management program must include monthly documentation of ALL of the following components:
      1. Weight tracking
      2. Dietary program compliance (e.g., food log or demonstrated weight loss)
      3. Physical activity (e.g., exercise program)
   4. Members with a BMI of 50 or above are not required to demonstrate recent participation in a weight loss program