Effective Jan. 1, 2018, upon plan renewal, bariatric surgeries will be excluded from coverage for fully insured commercial small group plans in Connecticut, and will be offered for purchase as an optional benefit for members of Connecticut fully insured large group plans.
This change aligns these products with the Connecticut Essential Health Benefits Benchmark Plan, which does not include bariatric surgeries as a covered benefit. For employer groups who choose to purchase bariatric surgeries as an added benefit, prior authorization will continue to be required. Coverage is based on medical necessity and member eligibility at the time of service.
Harvard Pilgrim will notify Connecticut members of the change in bariatric surgery coverage and any prior authorizations. Authorizations issued for bariatric surgeries will remain valid until the date that the member’s plan renews.
While coverage of bariatric surgeries for morbid obesity will be excluded for fully insured commercial small group plans in Connecticut, revision weight loss surgeries performed in response to a complication from a previous bariatric surgery (e.g., correcting a slipped gastric band) will continue to be covered.
You can determine member benefit eligibility the same way you do today, by checking HPHConnect or calling the Provider Service Center at 800-708-4414 and selecting option 3. Please see the Determining Eligibility Policy in our Provider Manual for more information.
Also, Harvard Pilgrim’s Gastroenterology Payment Policy has been updated to reflect the changes in coverage for bariatric surgeries.