What is Bariatric Management and why is it important?
Bariatric surgery is different from other kinds of surgery — it changes the way you’ll be able to eat and drink. After surgery, a much smaller amount of food and drink will fill you up than before. To be successful, you’ll need to start making changes before surgery and maintain them over the long run. A decision to undergo bariatric surgery is a lifelong commitment to a healthier lifestyle.
That’s why the Bariatric Management Program is so important. A specially trained bariatric nurse can guide you through the entire process — before, during, and after surgery. You’ll learn about medical requirements, different kinds of bariatric surgery, providers, and financial planning. You’ll also learn lifestyle skills as you prepare for surgery, including how to deal with complications, if any, after surgery. For six months after your surgery, you’ll have access to clinical guidance, tools, resources, and support so you can become a healthier you.
How Bariatric Management works
When you enroll, you’ll start working with a bariatric nurse, who will help you to:
- Understand whether you meet medical necessity criteria
- Learn what types of bariatric surgeries are covered under your plan
- Find an in-network provider, including a bariatric surgeon and a facility that is a Bariatric Center of Excellence
- Understand your financial obligations and find ways to meet them
- Use educational videos to prepare for surgery
- Discover new tools to help manage your health, both pre- and post-surgery
- Get the right help post-surgery to recover well and keep your new, healthier lifestyle habits
- Make appointments with the health care professionals you need
- Get answers to your questions
Do you qualify for bariatric surgery?
You, your representative, your primary care physician, or your surgeon can find out if you qualify for surgery by contacting Humana’s Bariatric Management Team. Your surgeon can fax or email clinical information requesting authorization for surgery. If you have a Health Maintenance Organization (HMO) plan, your primary care physician (PCP) can send your referral for bariatric surgery; your PCP should also send a copy to the surgeon’s office.
Once a request has been logged, a bariatric nurse in the Bariatric Management Team will check to see if you meet the medical criteria, and if necessary consult with the bariatric regional medical director. The nurse will also determine whether the bariatric hospital where the surgeon is affiliated is designated a Center of Excellence. To receive in-network certification, hospitals in Humana's bariatric surgery network must be certified as a Center of Excellence by The American Society of Metabolic and Bariatric Surgery or by the American College of Surgeons' Bariatric Surgery Center Network. The hospital and the surgeon also must be in your health plan's network for you to get the highest level of coverage. Humana's network of providers is growing rapidly, so call the Bariatric Management Program to find out if your surgeon and hospital meet your plan's coverage criteria.
How to enroll
Your member information is kept confidential. When contacting the Bariatric Management Team by email or fax, please include member name, Humana ID number, and date of birth. If you have billing questions, please call the customer service number on the back of your Humana ID card.