Medica's quality-focused "Centers of Excellence" initiative relies on evidence-based care to help ensure that Medica members get safe, quality care related to certain procedures.
Our Bariatric Care program identifies experienced surgeons and comprehensive surgical facilities that provide services related to bariatric care, including surgery for morbid obesity. Through an application process, surgeons and hospitals need to meet certain qualifications in order to achieve an approved designation for Medica's Centers of Excellence Program for Bariatric Care.
Important - Instructions for Coverage of Bariatric Surgery
In order to receive the highest level of benefits under your plan, please follow the instructions below prior to receiving bariatric surgery:
Contact Medica Customer Service at the telephone number on the back of your Medica ID card to verify that bariatric surgery is covered under your benefit.
Medica requires prior authorization (approval ahead of time) for bariatric surgery. When speaking to Customer Service, make sure you ask about the steps required to obtain a prior authorization.
In order for your bariatric surgery to be covered under your benefit, you must (a) use a clinic / physician and hospital in the Medica Centers of Excellence program, and (b) verify that the clinic / physician and hospital are in your health plan network. The document linked below lists the clinics / physicians and hospitals that are part of the Medica Centers of Excellence program, by state and city.
Follow the steps below:
(a) Choose the clinic / physician that best fits your needs. Note: Clinics / physicians must perform surgeries and admit patients only at the hospital listed to the right of their name in the table.
(b) To verify that the clinic / physician and hospital you have chosen are in your health plan network (i.e., Medica Choice, Passport from Medica), locate your health plan on the right-hand side of the table. An X in your health plan's column means you have chosen a network clinic / physician and hospital. If there is no X, you must choose a different clinic / physician and hospital.
Always double-check: Clinics / physicians and hospitals are added and removed from this list periodically. To be certain that you have chosen a network clinic / physician and hospital, contact Medica Customer Service at the telephone number on the back of your Medica ID card.
In some cases, a referral is also required. Follow these steps to verify if you will need a referral:
(a) Locate your health plan on the right-hand side of the table.
(b) Locate your clinic / physician.
(c) If you see an R in the health plan column that corresponds with your clinic / physician, a referral is required. If there is no R, a referral is not required.
View the document below to see a list of the clinics / physicians and hospitals that are part of the Medica Centers of Excellence program: