Definity Health covers weight loss surgery. To qualify for coverage of weight loss surgery, your policy must include coverage. Please note that not all policies include coverage. To find out if your policy includes coverage, please talk directly to Definity Health or an HR specialist if your insurance is provided by your employer.
Bio
Definity Health has been acquired by United Healthcare. The requirements listed are for United Healthcare as no specific information was available for Definity Health. However, the requirements for Definity Health are similar if not exactly the same.
Definity Health Pre-Approval Requirements
One of the most effective treatments for morbid obesity is a weight loss surgery procedure. Definity Health provides full coverage for bariatric procedures. However, there are certain requirements that a patient needs to fulfill in order to be eligible for coverage.
- The applicant must be at least 18 years old at the time the application is submitted.
- The patient should be suffering from Class-3 obesity, a body mass index (BMI) in excess of 40. However, patients with a BMI of 35 or more are also eligible for coverage provided the patient has at least one co-morbid condition. Common co-morbid conditions that a Class-2 obese patient suffers from include:
- Coronary artery disease
- Type-2 diabetes
- Obstructive sleep apnea
- Hypertension
- Impaired glucose tolerance
- Relevant documentation has to be presented by the patient stating that previous weight loss programs have been attempted but failed. These weight loss programs should have been attempted by the patient in the two years prior to the surgery.
- The weight loss programs should have included a diet program for at least six consecutive months or two diet programs of three consecutive months each.
- Generally documentation is also required stating that the patient requires bariatric surgery. The recommendation should be accompanied by a diagnosis of morbid obesity. A physician other than the operating surgeon should provide a letter of medical necessity.
Types of Weight Loss Surgeries Covered By Definity Health
The weight loss surgical procedures that are covered by Definity Health include:
- Gastric bypass
- Lap adjustable gastric bands
- Gastric sleeve surgery
- Vertical banded gastroplasty
- Biliopancreatic bypass
- Duodenal switch
The above mentioned procedures are covered for adults only. For pre-adults the following procedures are covered by Definity Health:
- Gastric bypass
- Lap gastric bands
- Gastric sleeve
Full coverage will be provided to patients who meet the above mentioned criteria.
Procedures Excluded From Coverage
There are certain procedures that are not covered by Definity Health. The procedures excluded from coverage are:
- Mini-gastric bypass
- ROSE
- Stomaphyx
- TOGA
- Gastric electrical stimulation
- And other procedures deemed experimental
Is A Second Weight Loss Surgery Covered If Lap Band Doesn’t Work?
Definity Health provides full coverage for a second weight loss surgery if the first procedure does not prove to be effective. The patient may have to show that they have followed the after surgery guidelines provided during the first procedure and were still unable to lose weight. The patient will need to meet the requirements of the original procedure to be eligible for a second surgery.
Revisions
Definity Health will cover any revisions to the bariatric surgery if the following criterions are met:
- The patient should have followed the dietary program and instructions of the surgeon post operation.
- There are complications relating to the surgical procedure that was performed.
Does Definity Health Require A Center Of Excellence?
It does not appear that an accredited Bariatric Center of Excellence is required by Definity Health.
Do I Have To Use An In-Network Bariatric Surgeon?
Definity Health does not list any specific requirements for using an in-network bariatric surgeon. However, in-network surgeons are recommended to avoid out-of-pocket expenditures.
Definity Health’s Contact Info to Inquire About Surgery
Definity Health can be contacted at 1-952-277-5500 to inquire about weight loss surgery.