Hope this helps. I have Hap as well and have just begun this process.
COVERAGE CRITERIA
Bariatric surgery is covered for HAP/AHL Members (other than Medicare Advantage) when all of the following criteria are met:
Member must be at least 18 years of age
Member's medical record must show documentation of one of the following:
BMI (Body Mass Index) 35 - 39.9 with at least one comorbidity requiring active treatment beyond lifestyle modification including but not limited to:
Cardiovascular disease
Diabetes mellitus
Sleep apnea
Hypertension
Hyperlipidemia
Pulmonary hypertension
BMI greater than or equal to 40 with or without co-morbid conditions
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:
Weight tracking
Dietary program compliance (e.g., food log or demonstrated weight loss)
Physical activity (e.g., exercise program)
Members with a BMI of 50 or above are not required to demonstrate recent participation in a weight loss program
