Common use of Bariatric Surgery Clause in Contracts

Bariatric Surgery. The procedure will be covered after a waiting period of twenty-four (24) months and meeting the following criteria: (a) Have a body mass index (BMI) of forty (40) or over and have been diagnosed as being morbidly obese; (b) Have a body mass index (BMI) between thirty-five (35) and forty (40) and has a serious weight-related health problem; (c) Can provide documented evidence of other methods of weight loss which have been tried over the past twenty-four (24) months, and (d) Have been through a psychological assessment which has confirmed that it is appropriate for the insured to undergo the procedure. The bariatric surgery technique needs to be evaluated by the insurer’s medical teams and is subject to the insurer’s medical policy criteria. The insured must contact the insurer for pre-authorization before proceeding with treatment. Benefit may not be paid unless pre-authorization has been provided.