HealthChoice to Implement Bariatric Surgery Pilot Program

HealthChoice is offering a Bariatric Surgery Pilot Program to 100 members starting January 1, 2013. The focus of this pilot program is to achieve quality outcomes and the improved health of our approved members.

The first 100 members that meet the participation and certification criteria will be allowed in the Bariatric Surgery Pilot Program. Clinical criteria is determined by certification through the HealthChoice certification administrator.

Participation criteria:

• Age 25–55
• Non-tobacco user
• No other primary group health coverage or primary coverage with Medicare
• Member must be covered under the HealthChoice plan 2 years prior to and 2 years after the approved surgery date
• HealthChoice USA and HealthChoice Alternative Plan participants are not eligible.

The Bariatric Surgery procedures available are:

• Band
• Sleeve
• Bypass

Prior to January 1, 2013, the pre-operative evaluation and additional medically necessary evaluations and testing provided by the participating Network Provider may be eligible subject to the HealthChoice plan of benefits and policy provisions. The 2012 and 2013 out of pocket maximums will apply to each calendar year.

Some complications of a Bariatric Surgery are included in the reimbursement until the member is discharged from the facility. Some complications may be billed separately prior to discharge. All services are subject to the HealthChoice plan of benefits and policy provisions. Complications that arise after the discharge date are subject to HealthChoice plan of benefits and policy provisions.

The Bariatric Surgical procedure is contracted only through the following Bariatric Surgery Centers of Excellence:

Bailey Medical Center, Owasso, Oklahoma 1-918-376-8410

1. Katsis, Steven, M.D. 1-918-272-6333
2. Kirk, JoeBob, D.O. 1-918-272-6333
3. Varnell, Brandon, M.D. 1-918-272-6333

Norman Regional Hospital, Norman, Oklahoma   1-405- 307-3028

1. Keith, Ronnie, D.O. 1-405-360-7100
2. Nelson, Lana, D.O. 1-405-735-2049

Only approved HealthChoice members that are certified for one of the procedures will receive benefits under this Bariatric Surgery Pilot Program.

If you have questions, call HP Administrative Services LLC at 1-405-416-1788 or 1-405-416-1782. For certification, please call APS Healthcare at 1-405-917-0815 or 1-405-917-0814.