TUFTS *** ADVANTAGE - MA

[Margie122 845]

I wrote to my health plan to ask what the specific requirements were for bariatric surgery. This is the response I got.

Hello

Thank you for your email inquiry.

Coverage for Bariatric Surgery for members age 18 and older is provided when authorized in advance by the Tufts Health Plan Pre-Certification Department. Coverage is for medically necessary surgery to treat morbid obesity when the member meets the Medical Necessity Guidelines submitted by the member's primary care physician or bariatric surgeon. Coverage is subject to the in-network deductible and any applicable co-insurance.

I am PUMPED!!!! I know that I meet the medical necessity guidelines. I know the surgery must be at a "Center of Excellence" and my hospital is on their Center of Excellence list. I feel so much better knowing this now.

[Margie122 845]

Ok....only part of the email I cut and pasted is showing up...very strange because I saw the whole thing in their,

Anyway I will type it out...

They said....

"Coverage for bariatric surgery for members age 18 and over is provided when authorized in advance by Tufts Health Plan Pre-Certification Department. coverage is for medically necessary surgery to treat morbid obesity when the member meets the medical necessity guidelines submitted by the members primary care physician or bariatric surgeon. Coverage is subject to the in- network deductibles and any applicable co-insurance."

I looked at the guidelines they attached - there were only two that I could see...must be over 18 and have surgery done at a center of excellence. My surgeon is at one of those centers I picked off their list.

Hope this post makes more sense now!