Bariatric Surgery Insurance Information for Wisconsin, 2018

Insurance CategoryCoverage of bariatric surgery for 2018Structural changes for 2018Reference
MedicareStandard Benefitshttps://www.medicare.gov/coverage/bariatric-surgery.html
MedicaidStandard Benefits
ACA Health ExchangeStandard Benefits

National Commercial Carriers

Insurance CompanyCoverage of bariatric surgery for 2018Structural changes for 2018Reference
Anthemyeshttps://www.anthem.com/medicalpolicies/policies/mp_pw_a053317.htm
Anthem Blue PreferredN/Aending Dec 2017http://etf.wi.gov/members/IYC2017/IYC_home.asp
Arise Health PlanN/Aending Dec 2017http://etf.wi.gov/members/IYC2017/IYC_home.asp
Cignayes*- though some plans exclude bariatric surgery
Dean Health Insuranceno
Dean Health Insurance- Prevea 360no
ETF Plans
GHCno
GundersenN/Abecoming Quartzhttp://etf.wi.gov/members/IYC2018/et-2107hpf.asp
Health TraditionN/Aending Dec 2017http://etf.wi.gov/members/IYC2017/IYC_home.asp
HealthPartnersnohttps://www.healthpartners.com/stateofwis/
Humana-EasternN/Aending Dec 2017http://etf.wi.gov/members/IYC2017/IYC_home.asp
Humana-WesternN/Aending Dec 2017http://etf.wi.gov/members/IYC2017/IYC_home.asp
IYC Access Planno"WEA Trust is the new administrator of the IYC Access Plan. If you are currently enrolled in the IYC Access Plan and take no action to change health plans during It’s Your Choice, you will be automatically enrolled with WEA Trust and will receive new ID cards in the mail prior to January 1, 2018."http://etf.wi.gov/members/IYC2018/et-2107pdpsp.asp
IYC Medicare Plusno"WEA Trust is the new administrator of IYC Medicare Plus. If you are currently enrolled in the IYC Medicare Plus and take no action to change health plans during It’s Your Choice, you will be automatically enrolled with WEA Trust and will receive new ID cards in the mail prior to January 1, 2018. There are no benefit changes in 2018, unless initiated by Medicare."http://etf.wi.gov/members/IYC2018/et-2107pdpmp.asp
IYC State Maintenance Plan (SMP)no"WEA Trust is the new administrator of SMP. If you enroll in SMP during It's Your Choice, you will receive new ID cards from WEA Trust in the mail prior to January 1, 2018.
SMP will only be offered in Florence County for 2018. It will no longer be offered in Bayfield, Buffalo, Forest, Iron, Marquette, Menominee and Pepin counties."
http://etf.wi.gov/members/IYC2018/et-2107pdpsmp.asp
Medical Associates Health Plansnohttps://www.mahealthcare.com/assets/pdf/MAHP/WISEDirectory_2018.pdf
MercyCare Health Plansno
Network Healthno
Physicians Plus Insurance Corp.N/Abecoming Quartzhttp://etf.wi.gov/members/IYC2018/et-2107hpf.asp
Quartz- Communitynohttps://unityhealth.com/docs/default-source/docs/2018-ETF-Local/sbc-wpe-local-health-plan-po6-community.pdf?sfvrsn=2
Quartz- UW Healthnohttps://unityhealth.com/docs/default-source/docs/2018-etf-state/sbc-state-iyc-health-plan-uw-health.pdf?sfvrsn=2
Security Health Plan of WI, Inc.no
United Healthcareyes*- though some plans exclude bariatric surgery
UnitedHealthcare of Wisconsin, Inc.N/Aending Dec 2017http://etf.wi.gov/members/IYC2018/et-2107hpf.asp
Unity Health Plan Insurance Corp.N/Abecoming Quartzhttp://etf.wi.gov/members/IYC2018/et-2107hpf.asp
WEA TrustnoWill now be the administrator for Access Plan, Medicare Plus, and State Maintenance Planhttp://etf.wi.gov/members/IYC2018/et-2107hpf.asp
WPS Health Plan, Inc.N/Aending Dec 2017; members will be automatically transitioned to WEA Trust by defaulthttp://etf.wi.gov/members/IYC2018/et-2107hpf.asp

WI HMO Plans

Insurance CategoryCoverage of bariatric surgery for 2018Structural changes for 2018Reference
WI HMO Plans
Aspirus Arise Health Plan of Wisconsinyeshttps://www.aspirusarise.com/wps/wcm/connect/whi/f63d4a96-e51e-4123-92aa-9581e60ed22c/Aspirus+Arise+Bariatric+Surgery+Effective+7-1-17.pdf?MOD=AJPERES&CVID=lOEs0Gj&ContentCache=NONE&CACHE=NONE
Children's Community Health Plannohttps://childrenscommunityhealthplan.org/Marketplace/Benefit-Plans-2018
Compcare Health Servicesyes
Dean Health Planyes
Group Health Cooperative of Eau Clairenohttps://www.group-health.com/docs/Members/State/OpenEnrollment/2018/SBC-State-HDHP.pdf
Group Health Cooperative of South Central Wisconsinnohttps://www.ghcscw.com/SiteCollectionDocuments/2017_FEHB_Plan_Summary_of_Benefits_Coverage.pdf
Health Tradition Health Planno"Individual and family health plans will not be offered for 2018." "[Large group] Plans with effective dates beginning April 1, 2018 will not be available." "Health Tradition has decided to phase out its health plans over the next several years. This will be a gradual process, and you will have plenty of time to transition to new plan options which also offer Mayo Clinic care."https://www.healthtradition.com/home/coverage-summary-for-groups/
Humana Wisconsin Health Org.N/A"Humana will no longer offer individual medical plans starting next year, in 2018."https://www.humana.com/individual-and-family-support/tools/aca
The Medical Associates Clinic Health Plan of Wisconsinyeshttp://www.co.grant.wi.gov/docview.asp?docid=17388&locid=147 http://ww2.mahealthcare.com/WI/2017-LG-WI.pdf
MercyCare HMOnohttps://mercycarehealthplans.com/mercycare-wi-individuals-2018/
Network Health Planyeshttps://networkhealth.com/_files/pdf/Provider/Authorization_forms/StateofWisconsinAuthList.pdf
Security Health Plan of WI, Inc.no" Coverage for hospital services provided to Family Health Center members is limited to outpatient care only... Hospital charges… are not reimbursed for Family Health Center members "https://www.securityhealth.org/provider-manual
WPS Health Plan (Arise)no"Health care services provided in connection with a diagnosis of obesity, weight control, or weight reduction,
regardless of whether such services are prescribed by a health care practitioner or associated with an illness or
injury…"
https://secure.wpsic.com/sales-materials/files/26534-1801_individual-hmo-certificate.pdf (page 45) https://www.wpsic.com/providers/files/bariatric-surgery.pdf https://www.wpsic.com/members/find_sbc/2018/arise/files/84670WI1250146.pdf
Quartzlarge groups are typically included, while small groups, individual, & family plans are typically excludedManages Gundersen Health Plan, Physicians Plus, & Unity Health Insurancehttps://unityhealth.com/docs/default-source/docs/2018-ETF-Local/sbc-wpe-local-health-plan-po6-community.pdf?sfvrsn=2
*These results are based on our review and accessible information regarding insurance coverage. Always check with your provider to verify whether or not your plan includes the procedure in question.