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Accidentalcynic

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Everything posted by Accidentalcynic

  1. Accidentalcynic

    HAP - Health Alliance Plan

    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

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