HAP - Health Alliance Plan

[Stacy160 201]

Looks like our new insurance plan this year will be HAP. They do cover WLS, but I don't yet know if OUR plan includes it. Has anyone had HAP cover this, and if so, what hoops did you have to jump though to get it done? Thanks!

[NancySmiles 2]

I am the Lap-Band Program Director at our office and HAP will cover the surgery only if it is done at a HAP facility. Our hospital takes HAP patients; but HAP will only pay for bariatric surgery at their hospital. Any other surgery is usually ok.

[Stacy160 201]

Nancy, thank you! It looks like we're not changing until April 1st (nobody at this company really has a clue what's going on, including the people supposedly in charge of this). Maybe you can answer another question for me: If my primary Dr. is affiliated with a HAP hospital where the lap band procedure is not performed, will HAP pay for me to go to a DIFFERENT HAP hospital where it is? Thanks! :welldone:

[Stacy160 201]

OH! And do you know offhand what HAP's requirements are? Don't go digging for them unless you already know, I'll find out in a few months anyway. Thanks!

[sweettea25 0]

yes i would like to know also.

[Accidentalcynic 0]

On 10/16/2008 at 6:23 PM, sweettea25 said:

yes i would like to know also.

Hope this helps. I have Hap as well and have just begun this process.

COVERAGE CRITERIA

1. Bariatric surgery is covered for HAP/AHL Members (other than Medicare Advantage) when all of the following criteria are met:
   1. Member must be at least 18 years of age
   2. Member's medical record must show documentation of one of the following:
      1. BMI (Body Mass Index) 35 - 39.9 with at least one comorbidity requiring active treatment beyond lifestyle modification including but not limited to:
         1. Cardiovascular disease
         2. Diabetes mellitus
         3. sleep apnea
         4. Hypertension
         5. Hyperlipidemia
         6. Pulmonary hypertension
      2. BMI greater than or equal to 40 with or without co-morbid conditions
   3. 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:
      1. Weight tracking
      2. Dietary program compliance (e.g., food log or demonstrated weight loss)
      3. Physical activity (e.g., exercise program)
   4. Members with a BMI of 50 or above are not required to demonstrate recent participation in a weight loss program