Bariatric Surgery Insurance Information for Wisconsin, 2018

Insurance Category Coverage of bariatric surgery for 2018 Structural changes for 2018 Reference
Medicare Standard Benefits https://www.medicare.gov/coverage/bariatric-surgery.html
Medicaid Standard Benefits
ACA Health Exchange Standard Benefits
Commercial Insurers
National Carriers
Anthem yes https://www.anthem.com/medicalpolicies/policies/mp_pw_a053317.htm
Cigna yes*- though some plans exclude bariatric surgery
United Healthcare yes*- though some plans exclude bariatric surgery
ETF Plans
Anthem Blue Preferred N/A ending  Dec 2017 http://etf.wi.gov/members/IYC2017/IYC_home.asp
Arise Health Plan N/A ending Dec 2017 http://etf.wi.gov/members/IYC2017/IYC_home.asp
Dean Health Insurance no
Dean Health Insurance- Prevea 360 no
GHC no
Gundersen N/A becoming Quartz http://etf.wi.gov/members/IYC2018/et-2107hpf.asp
Health Tradition N/A ending  Dec 2017 http://etf.wi.gov/members/IYC2017/IYC_home.asp
HealthPartners no https://www.healthpartners.com/stateofwis/
Humana-Eastern N/A ending  Dec 2017 http://etf.wi.gov/members/IYC2017/IYC_home.asp
Humana-Western N/A ending  Dec 2017 http://etf.wi.gov/members/IYC2017/IYC_home.asp
IYC Access Plan no “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 Plus no “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 Plans no https://www.mahealthcare.com/assets/pdf/MAHP/WISEDirectory_2018.pdf
MercyCare Health Plans no
Network Health no
Physicians Plus Insurance Corp. N/A becoming Quartz http://etf.wi.gov/members/IYC2018/et-2107hpf.asp
Quartz- Community no https://unityhealth.com/docs/default-source/docs/2018-ETF-Local/sbc-wpe-local-health-plan-po6-community.pdf?sfvrsn=2
Quartz- UW Health no https://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
UnitedHealthcare of Wisconsin, Inc. N/A ending  Dec 2017 http://etf.wi.gov/members/IYC2018/et-2107hpf.asp
Unity Health Plan Insurance Corp. N/A becoming Quartz http://etf.wi.gov/members/IYC2018/et-2107hpf.asp
WEA Trust no Will now be the administrator for Access Plan, Medicare Plus, and State Maintenance Plan http://etf.wi.gov/members/IYC2018/et-2107hpf.asp
WPS Health Plan, Inc. N/A ending  Dec 2017; members will be automatically transitioned to WEA Trust by default http://etf.wi.gov/members/IYC2018/et-2107hpf.asp
WI HMO Plans
Aspirus Arise Health Plan of Wisconsin yes https://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 Plan no https://childrenscommunityhealthplan.org/Marketplace/Benefit-Plans-2018
Compcare Health Services yes
Dean Health Plan yes
Group Health Cooperative of Eau Claire no https://www.group-health.com/docs/Members/State/OpenEnrollment/2018/SBC-State-HDHP.pdf
Group Health Cooperative of South Central Wisconsin no https://www.ghcscw.com/SiteCollectionDocuments/2017_FEHB_Plan_Summary_of_Benefits_Coverage.pdf
Health Tradition Health Plan no “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 Wisconsin yes http://www.co.grant.wi.gov/docview.asp?docid=17388&locid=147 http://ww2.mahealthcare.com/WI/2017-LG-WI.pdf
MercyCare HMO no https://mercycarehealthplans.com/mercycare-wi-individuals-2018/
Network Health Plan yes https://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
Quartz large groups are typically included, while small groups, individual, & family plans are typically excluded Manages Gundersen Health Plan, Physicians Plus, & Unity Health Insurance https://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.