OEBB

When it’s needed

Coverage for gastric bypass is for plan subscribers (policy holders) only who are 18 years or older. In addition, there is a six month waiting period that must be met before the surgery can be performed. The six month waiting period begins on October 1, 2012.

There is a $500 copay for gastric bypass surgery, plus you must meet your deductible. You will be reimbursed 80 percent of the cost of the surgery.

You must use one of the approved Centers of Excellence in order to receive this benefit. There is no out-of-network benefit.

The reference price for gastric bypass surgery is $20,000.

To be eligible for gastric bypass surgery, you must have completed these eligibility requirements in the last six months:

Medical record documentation that none of the previous weight loss efforts have been sustained and sufficient to address the co-existing medical condition(s) and/or co-morbidity conditions applicable to the patient.

Surgery requirements

Surgeries must be performed at a Center of Excellence Network recognized by OEBB.

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