The primary goal of the Bariatric Management Program is to provide members with the necessary tools to lead to healthier lives and achieve long-term weight loss success.
If you are interested in participating in the Bariatric Management Program or if you have any questions, please contact our Program Manager at 866-330-9886 or weightloss@hmpsd.com.
Guidelines to determine eligibility for bariatric surgery are as follows:
- The member has a body mass index (BMI) of 40 or greater or member has a BMI of 35 or greater and a clinically serious condition exists (e.g., sleep apnea, diabetes, high blood pressure, arthritis).
- The member must have failed non-surgical weight loss through a physician-approved program with or without pharmacotherapy.
- No specifically correctable cause for obesity (e.g., an endocrine disorder) has been identified.
- Member has achieved full growth (determined by physician).
The Bariatric Management Program is managed in four phases and the phases are outlined below.
Steps to complete Phase I: Evaluation
Step 1- Member must contact Health Management Partners, Inc. to start the enrollment process. Members will then be mailed an information packet.
Step 2- After enrolled in the program, make an appointment with your primary care physician. The following expenses will be covered at 100% when provided by an In-State Dakotacare provider:
- 1 Office Visit
- 1 HbA1c (Glucose 3 month average)
- 1 Fasting Blood Sugar (Fasting Glucose)
- 1 Lipid Profile (Cholesterol, HDL, LDL and Triglycerides)
Your primary care physician will need to refer you to an approved facility that has obtained certification in Bariatric Surgery. The following facilities are approved:
Surgical Institute of South Dakota
(Avera McKennan Hospital)
911 E 20th Street, Suite 800
Sioux Falls, SD 57105
Phone: (605) 334-0393
Sanford Surgical Associates
(Sanford USD Medical Center)
1508 W 22nd Street, Suite 101
Sioux Falls, SD 57105
Phone: (605) 328-3840
Regional Weight Management Center
(Rapid City Regional Hospital)
2908 5th Street
Rapid City, SD 57701
Phone: (605) 719-1375
Avera Bariatric Center
2200 N Kimball, Suite 950
Mitchell, SD 57301
Phone: (605) 605-996-5482
Step 3- Once you have chosen a surgeon from the list above, a surgical, nutritional and psychological evaluation need to be completed and submitted to Health Management Partners, Inc. Your nutritional evaluation will be covered at 100% when provided by an In-State Dakotacare provider. One surgical and psychological evaluation will be covered at normal plan benefits per lifetime limits. All evaluations will need prior authorization in order to be covered. Facilities may submit pre-authorization requests online at www.preauthonline.com.
- Surgical Evaluation- Provides the opportunity for the surgeon to review your health history, assess your current condition, and provide guidance about the potential of the procedure and your surgical options.
- Nutritional Evaluation- The dietitian will assess your dietary habits and behaviors while providing education about the post-surgical dietary and nutritional needs.
- Psychological Evaluation- Assesses your past and present mental and emotional status as a gauge of potential success following a bariatric procedure and the adjustment to your new life and lifestyle.
Step 4- Once Health Management Partners, Inc. has received all three evaluations our Medical Director will make a recommendation whether the member needs to participate in 6 months of the Bariatric Management Program (phase II) or proceed directly to surgery (phase III).
Step 5- Health Management Partners, Inc. staff will inform you of the Medical Director’s decision and guide you to the next phase.
Steps to complete Phase II: 6 Month Compliance
Step 1- The Member must agree to participate in the surgeon’s multidisciplinary program for weight loss and weight management. Weight gain of more than five pounds from the weight submitted during Phase I will be considered *non-compliance and the member will become ineligible for surgery.
Step 2- After the six months are completed, the member must be weighed by their primary care physician office for official documentation of no weight gain. Your primary care physician office will need to fax weight to 605-977-0185 attn: Bariatric Management Program for confirmation of no weight gain.
Step 3- If no weight gain has occurred and the member has complied with surgeon’s requirements, the member may proceed to phase III.
*If a member becomes ineligible for surgery due to non-compliance or if a member chooses not to proceed with surgery, they may reapply to the program after twelve months. However, any evaluations done during the first time frame will have to be done again and none of the cost of the evaluations will be covered by the plan.
Steps to complete Phase III: Bariatric Surgery
Step 1- Themember will be sent an approval letter for surgery. We will notify your surgeon’s office of surgery approval. The member will need to contact the surgeon’s office to schedule the procedure.
Step 2- Notify Health Management Partners, Inc. once a surgery date has been scheduled. Your surgeon’s office will need to pre-authorize your surgery by going online to www.preauthonline.com
Step 3- Surgery completion.
Steps to complete Phase IV: Skin Reduction Surgery
One skin reduction surgery is allowed per lifetime once the member has completed 12 months in the Bariatric Management Program after surgery and the member reaches their weight loss goal. At that time a member may be eligible for an abdominal panniculectomy (abdominal skin apron/excess skin of the abdomen) or Brachiaplasty (removal of the excess skin under the arms) or thigh lift/thigh reduction surgery.
Step 1- The Member must agree to participate in the surgeon’s multidisciplinary program for weight loss and weight management for at least 12 months after surgery or member reaches their weight loss goal.
Step 2- After at least 12 months of participation post Bariatric Surgery the member will receive a letter informing them of eligibility for skin reduction surgery. If you have met your weight loss goal and are ready to proceed with your skin reduction surgery you will need to have your primary care physician or surgeon’s office fax your current weight to 605-977-0185, attn: Bariatric Management Program. Once we have received confirmation of your weight loss you will be eligible for surgery.
Step 3- Approval for your skin reduction surgery indicates you have successfully completed the Bariatric Management Program. Your surgeon’s office will need to pre-auth the surgery by going online to www.preauthonline.com.
Click here for the weight management fact library!
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