Morbid Obesity Surgery Sample Clauses

Morbid Obesity Surgery. The plan covers surgical treatment of morbid obesity provided all of the following are true: • You have a minimum Body Mass Index (BMI) greater than 40 kilograms per meter squared, or equal to or greater than 35 kilograms per meter squared with one of the following co-morbid conditions: ▪ Hypertension; ▪ A cardiopulmonary condition; ▪ Sleep apnea; or ▪ Diabetes. • You must enroll in the Optum Bariatric Resource Services (BRS) program, a surgical weight loss solution for those individual(s) who qualify clinically for Morbid Obesity Surgery. Covered participants seeking coverage for bariatric surgery should notify Optum as soon as the possibility of a bariatric surgery procedure arises (and before the time a pre-surgical evaluation is performed) at a bariatric surgery center by calling Optum at (000) 000-0000 to enroll in the program. • You have completed a multi-disciplinary surgical preparatory regimen, which includes a psychological evaluation. • You have a 3-month Physician supervised diet documented within the last 2 years.
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Morbid Obesity Surgery. The plan covers surgical treatment of morbid obesity provided all of the following are true: • For adolescents ,you have achieved greater than 95% of estimated adult height AND a minimum Xxxxxx Stage of 4. • You have a minimum Body Mass Index (BMI) of 40, or > 35 with at least 1 co-morbid condition present. • You must enroll in the Optum Bariatric Resource Services (BRS) program, a surgical weight loss solution for those individual(s) who qualify clinically for Morbid Obesity Surgery. • You have completed a multi-disciplinary surgical preparatory regimen, which includes a psychological evaluation. • You have a 3-month Physician supervised diet documented within the last 2 years. • One surgery per lifetime unless complications. • Excess skin removal post bariatric surgery is not covered, unless Medically Necessary.
Sample 1
Morbid Obesity Surgery. The plan covers surgical treatment of morbid obesity also known as bariatric surgery, provided all of the following are true: • For adolescents, you have achieved greater than 95% of estimated adult height AND a minimum Xxxxxx Stage of 4. • You have a minimum Body Mass Index (BMI) of 40, or > 35 with at least 1 co-morbid condition present. • You must enroll in the Optum Bariatric Resource Services (BRS) program, a surgical weight loss solution for those individual(s) who qualify clinically for Morbid Obesity Surgery. • You have completed a multi-disciplinary surgical preparatory regimen, which includes a psychological evaluation. SAMPLE • You have a 3-month Physician supervised diet documented within the last 2 years. • Excess skin removal post bariatric surgery is not covered, unless Medically Necessary. Necessary Medical Supplies Medical supplies that are used with covered DME are covered when the supply is necessary for the effective use of the item/device (e.g., oxygen tubing or mask, batteries for power wheelchairs and prosthetics, or tubing for a delivery pump). • Ostomy Supplies are also covered and limited to the following: ♦ Irrigation sleeves, bags and ostomy irrigation catheters. ♦ Pouches, face plates and belts. ♦ Skin barriers. Note: Benefits are not available for deodorants, filters, lubricants, tape, appliance cleaners, adhesive, adhesive remover, or other items not listed above (check the member specific benefit plan document for coverage of ostomy supplies). • Urinary Catheters: Benefits are also covered for external, indwelling and intermittent urinary catheters for incontinence or retention. Benefits include related urologic supplies for indwelling catheters limited to: ♦ Urinary drainage bag and insertion tray (kit). ♦ Anchoring device. ♦ Irrigation tubing set Orthotics Orthotic devices means rigid or semi-rigid supportive devices that restrict or eliminate motion of a weak or diseased body part. Orthotic braces, including needed changes to shoes to fit braces, braces that stabilize an injured body part and braces to treat curvature of the spine are a Covered Health Care Service. This includes orthotic devices for the correction of positional plagiocephaly, including dynamic orthotic cranioplasty (DOC) bands (limited to once per lifetime) and soft helmets. Benefits are available for fitting, repairs and replacement, except as described in Section 2: Exclusions and Limitations. Pharmaceutical Products - Outpatient Pharmaceutical Products...
Sample 1
Morbid Obesity Surgery. Morbid Obesity Surgery must be received from a Designated Provider. Depending upon where the Covered Health Care Service is provided, Benefits will be the same as those stated under each Covered Health Care Service category in this Schedule of Benefits.
Sample 1
Morbid Obesity Surgery. Morbid Obesity surgery must be received from a Designated Provider. 30% Yes Yes
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Morbid Obesity Surgery. Morbid Obesity surgery must be received from a Designated Provider. Limited to one bariatric surgery per lifetime unless determined to be Medically Necessary to correct or reverse complications from a previous bariatric procedure. None Yes Yes
Sample 1

Related to Morbid Obesity Surgery

  • Outpatient Dental Anesthesia Services This plan covers anesthesia services received in connection with a dental service when provided in a hospital or freestanding ambulatory surgical center and: • the use of this is medically necessary; and • the setting in which the service is received is determined to be appropriate. This plan also covers facility fees associated with these services.

  • Radiation Therapy/Chemotherapy Services This plan covers chemotherapy and radiation services. Respiratory Therapy This plan covers respiratory therapy services. When respiratory services are provided in your home, as part of a home care program, durable medical equipment, supplies, and oxygen are covered as a durable medical equipment service.

  • Surgery a) The performance of generally accepted operative and cutting procedures, including surgical diagnostic procedures, specialized instrumentations, endoscopic examinations, and other procedures;

  • Infusion Therapy the administration of antibiotic, nutrients, or other therapeutic agents by direct infusion. Note: The limitations on Therapy Services contained in this Therapy Services provision do not apply to any Therapy Services that are received under the Home Health Care provision or to therapy services received under the Diagnosis and Treatment of Autism or Other Developmental Disabilities provision. .

  • Hepatitis B Vaccine Where the Hospital identifies high risk areas where employees are exposed to Hepatitis B, the Hospital will provide, at no cost to the employees, a Hepatitis B vaccine.

  • Medical Exams 18.1: The Sheriff's Department may require a physical and/or psychological exam by a doctor, at the Employer's expense, to determine the employee's ability to perform his/her regular duties, if deemed appropriate. The employee may obtain a second opinion, at the employee's expense, and in the event there is a dispute between the Employer's doctor and the employee's doctor, both of these doctors shall select a third doctor, whose decision shall be final and binding on the parties. The expense for the third doctor's opinion shall be split 50-50 by the Employer and the employee if not covered by the employee's insurance.

  • Therapies Acupuncture and acupuncturist services, including x-ray and laboratory services. • Biofeedback, biofeedback training, and biofeedback by any other modality for any condition. • Recreational therapy services and programs, including wilderness programs. • Services provided in any covered program that are recreational therapy services, including wilderness programs, educational services, complimentary services, non- medical self-care, self-help programs, or non-clinical services. Examples include, but are not limited to, Tai Chi, yoga, personal training, meditation. • Computer/internet/social media based services and/or programs. • Recreational therapy. • Aqua therapy unless provided by a physical therapist. • Maintenance therapy services unless it is a habilitative service that helps a person keep, learn or improve skills and functioning for daily living. • Aromatherapy. • Hippotherapy. • Massage therapy rendered by a massage therapist. • Therapies, procedures, and services for the purpose of relieving stress. • Physical, occupational, speech, or respiratory therapy provided in your home, unless through a home care program. • Pelvic floor electrical and magnetic stimulation, and pelvic floor exercises. • Educational classes and services for speech impairments that are self-correcting. • Speech therapy services related to food aversion or texture disorders. • Exercise therapy. • Naturopathic, homeopathic, and Christian Science services, regardless of who orders or provides the services. Vision Care Services • Eye exercises and visual training services. • Lenses and/or frames and contact lenses for members aged nineteen (19) and older. • Vision hardware purchased from a non-network provider. • Non-collection vision hardware. • Lenses and/or frames and contact lenses unless specifically listed as a covered healthcare service.

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