Fidelis Requirements for Bariatric Surgery | What You Need to Know

Fidelis Fidelis Fidelis Requirements for Bariatric Surgery

As an attorney specializing in healthcare law, I have always been fascinated by the regulations and requirements surrounding bariatric surgery, particularly when it comes to insurance coverage. Fidelis Care, a leading healthcare provider in New York, has specific guidelines in place for coverage of bariatric surgery, and understanding these requirements is crucial for both patients and healthcare providers.

Understanding Care

Fidelis Care is a state-wide health insurance program that offers coverage to more than 1.7 million members New York. As part of their coverage, Fidelis Care provides benefits for bariatric surgery for qualifying individuals. However, meeting the specific requirements set forth by Fidelis Care is essential for patients seeking coverage for this life-changing procedure.

Fidelis Fidelis Fidelis Requirements for Bariatric Surgery

According to Fidelis Care`s policy, coverage for bariatric surgery is available for members who meet specific medical criteria. These criteria may include a body mass index (BMI) of 40 or more, or a BMI of 35 or more with at least one obesity-related comorbidity. Additionally, patients must demonstrate a history of unsuccessful weight loss attempts through other means such as diet and exercise.

Statistics Case Studies

Research has shown that bariatric surgery can lead to significant and sustained weight loss, as well as improvement in obesity-related comorbidities such as diabetes, hypertension, and sleep apnea. In study published New England Journal Medicine, patients underwent bariatric surgery experienced average weight loss 26% total body weight Remission of Type 2 Diabetes 86% cases.

Statistic Percentage
Average Weight Loss 26%
Remission of Type 2 Diabetes 86%

These statistics demonstrate the significant impact bariatric surgery can have on patients` health and quality of life, highlighting the importance of meeting the requirements for coverage under Fidelis Care.

Advocating Patients

As an attorney, I am passionate about advocating for patients` rights to access necessary medical care. Understanding the specific requirements set forth by Fidelis Care for bariatric surgery is essential for ensuring that patients receive the coverage they are entitled to. By staying informed and up-to-date on these requirements, I am able to provide valuable guidance and support to individuals seeking coverage for bariatric surgery.

Care`s requirements bariatric surgery coverage designed ensure procedure accessible benefit most. By meeting specific medical criteria, patients can access this life-changing treatment and improve their overall health and well-being. As an attorney, I am committed to supporting patients in navigating these requirements and advocating for their right to receive the care they need.

Legal Q&A: Fidelis Fidelis Fidelis Requirements for Bariatric Surgery

Question Answer
1. What are the eligibility requirements for bariatric surgery under Fidelis? Well, let me tell you, Fidelis requires patients to have a body mass index (BMI) of 40 or higher, or a BMI of 35 or higher with obesity-related health conditions. Patients must also have documented evidence of past unsuccessful attempts at weight loss through diet and exercise. It`s walk park, for sure.
2. What documentation is needed to prove eligibility for bariatric surgery under Fidelis? Now, where gets tricky. Fidelis typically requires medical records documenting the patient`s weight, BMI, previous weight loss attempts, and any obesity-related health conditions. In some cases, they may also require psychological evaluations to assess the patient`s readiness for surgery. It`s whole ordeal, it`s best, know?
3. Are age restrictions bariatric surgery coverage Care? As age goes, generally requires patients ages 18 65 bariatric surgery coverage. Want make sure patient age capable making informed decision surgery. Safety first, right?
4. Does Fidelis cover all types of bariatric surgery procedures? Now, not bariatric surgery procedures treated equal by typically cover procedures gastric bypass, gastric sleeve, adjustable gastric banding. However, experimental or unproven procedures may not be covered. They`re all about evidence-based medicine, you know?
5. What is the appeals process if Fidelis denies coverage for bariatric surgery? If Fidelis denies coverage, patients have the right to appeal the decision. The appeal process typically involves submitting additional medical documentation and supporting evidence to justify the necessity of the surgery. It`s a bit of a battle, but it`s worth fighting for what you believe in, right?
6. Will Fidelis cover the costs of pre-operative counseling and education for bariatric surgery? Pre-operative counseling and education are often covered by Fidelis as part of the bariatric surgery process. They want to make sure patients are fully informed and prepared for the surgery, both physically and mentally. It`s setting stage success, know?
7. Are there any specific dietary or lifestyle requirements before undergoing bariatric surgery with Fidelis coverage? Before bariatric surgery, Fidelis may require patients to undergo dietary and lifestyle counseling to prepare for the changes post-surgery. This could include dietary restrictions, physical activity guidelines, and other lifestyle modifications. It`s part journey healthier life, it?
8. Does Fidelis provide coverage for post-operative care and follow-up appointments after bariatric surgery? Post-operative care and follow-up appointments are typically covered by Fidelis as part of the bariatric surgery process. Want make sure patients supported monitored recover adjust new lifestyle. It`s accountability support, know?
9. Are exclusions limitations bariatric surgery coverage Care? Fidelis may have exclusions or limitations for bariatric surgery coverage, such as cosmetic procedures or surgeries performed by non-credentialed providers. It`s important to carefully review the policy for any specific exclusions before undergoing surgery. It`s knowing rules game, right?
10. What I questions concerns coverage bariatric surgery? If you have questions or concerns about Fidelis coverage for bariatric surgery, it`s best to contact their customer service or member services department directly. They can provide specific information about your policy and coverage options. Always good direct line communication, it?

Fidelis Fidelis Fidelis Requirements for Bariatric Surgery

This contract outlines the requirements and obligations for bariatric surgery under Fidelis insurance.


Parties Insurance Company Patient
Scope This contract outlines the requirements for bariatric surgery coverage under Fidelis insurance policy.
Requirements The patient must meet following requirements eligible coverage bariatric surgery:

  • Body Mass Index (BMI) 35 higher
  • Documentation least 6 months supervised weight loss attempts
  • Evidence obesity-related comorbidities
Obligations Fidelis insurance will cover the cost of bariatric surgery if the patient meets the requirements outlined in this contract. The patient must provide all necessary documentation and adhere to post-surgery guidelines.
Governing Law This contract shall be governed by the laws of the state of [State].
Signatures _____________________________
Insurance Company