Bariatric Care
The Medica Bariatric Care Centers of Excellence program will be discontinued. Effective January 1, 2024, it will no longer be a separate member benefit for Individual and Family Business (IFB) members. And starting on January 1, 2024, for employer groups, the program and related benefit will be discontinued for commercial members upon the group’s coverage renewal date. As a result, certain groups may continue to offer the benefit through late 2024, so it is important for provider offices to verify member benefits prior to service, as well as continue to request prior authorization for bariatric services.
Once the Centers of Excellence Bariatric Care program is no longer available, providers won’t be restricted to using approved Centers of Excellence facilities. Standard benefits will apply for in-network vs. out-of-network facilities subject to prior authorization — bariatric procedures will be covered as part of a member’s standard surgical benefit.
Safe, High-Quality Care for Medica Members
"Centers of Excellence" for bariatric surgery is a quality-focused clinical initiative that focuses on ensuring members receive safe care from facilities. This program identifies surgical facilities accredited to provide bariatric care, including surgery for morbid obesity and related services.
Facilities that meet certain qualifications may qualify for accreditation by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP®). More information can be found at www.facs.org.
Medica network facilities that hold active, unrestricted MBSAQIP accreditation qualify for recognition as Medica Bariatric Centers of Excellence and are eligible for reimbursement of bariatric surgical procedures or revisions considered non-investigative.
Note: If your facility earns MBSAQIP accreditation, or has a change in accreditation status, please notify your Medica contract manager so we can update our records.
A Medica member's coverage may vary according to the terms of the member’s coverage document.
Reminders:
- Prior authorization is required for all bariatric surgeries.
- Coverage for bariatric surgery may vary considerably. Providers and
members are encouraged to contact Medica by calling the phone number on the back of the member ID card to verify benefits before the member receives any services.
- Members must verify the facility is part of their network and is also designated as a Center of Excellence, if required.
List of approved facilities for the Medica Centers of Excellence Program for Bariatric Care (PDF)
Transplant Program
Medica has contracted with Optum Health for access to their Transplant Network. This network has transplant programs that perform high quality, high volume transplants with recognized Center of Excellence outcomes.
Optum reviews each transplant program annually to determine in-network status. Each transplant program is reviewed individually to determine status.
The types of transplants performed for adults and pediatrics are as follows:
- Bone Marrow or Stem Cell (Peripheral or Umbilical Cord Blood)
- Heart
- Lung
- Liver
- Kidney
- Pancreas
- Intestinal
- Multi-Organ
Medica requires prior authorization for transplant evaluation and transplant services. For information regarding prior authorization, please review the utilization management policies and form.
For additional information regarding Medica’s Transplant Network and Case Management Programs, please call 1(866) 905-7430 or email us.
Rev 10/2023