Obesity (bariatric) surgery is covered only in very specific clinical circumstances, including co-morbid conditions, and must be preauthorized by the plan. The plan will cover the surgery only if the patient meets all program requirements, including those for before and after surgery. The final decision as to whether the surgery will be covered is made by a plan Medical Director after all presurgical requirements are met. Approval will not be granted to patients who had previous bariatric surgery within the last 10 years or any prior bariatric surgery covered by a health plan available through the Public Employees Benefits Board (PEBB). The member must use providers and facilities designated by the plan.

The plan covers only certain types of bariatric surgery procedures. No other procedure will be considered for coverage.

TIP:  Members who want to be evaluated for the obesity presurgical program must complete the online questionnaire. If you do not have internet access, call Customer Service at 1-800-762-6004 to request a questionnaire.