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HAP - Health Alliance Plan



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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! :(

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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.

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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:

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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!

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yes i would like to know also.

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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

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