Common use of Bariatric Surgery Clause in Contracts

Bariatric Surgery. This benefit has one or more exclusions as specified in the Exclusions section. Surg cal treatment of morbid obesity (bariatric surgery) is Covered only if it is Medically Necessary as defined in this Agreement.  Bariatric surgery is Covered for patients with a Body Mass Index (BMI) of 35 kg/m2 or greater who are at high risk for increased morbidity due to specific obesity related co- morbid medical conditions; and  I a Covered Benefit only if a Member meets this criteria and all other requirements of t is Agreement. Prior Auth Required Prior Authorization is required and services must be performed at an In-network facility that is designated by Presbyterian Health Plan, and designated as a bariatric surgery Center of Excellence by Centers for Medicare and Medicaid Services (CMS).  Cancer Clinical Trials Exclusion This benefit has one or more exclusions as specified in the Exclusions section Routine patient care costs that are incurred as a result of participation in a Cancer Clinical Trial in New Mexico are Covered.  Routine patient care costs mean: o Medical service or treatment that is a benefit under this Health Benefits Plan would be Covered if the patient were receiving standard cancer treatment or that