What changes has the plan made regarding weight loss (bariatric) surgery?
The self funded PPO Plan has experienced an increase in utilization from out of network outpatient and inpatient facilities (hospitals). Even with the reduced out of network benefits, some of the costs have been in excess of in-network benefits paid. To encourage participants to utilize in-network facilities, effective November 1, 2009, the Plan will include the following provision: “Weight loss surgeries should be performed at an in-network (PPO) outpatient or inpatient facility, payment will be reduced to an amount equal to that of the nearest in-network outpatient or inpatient facility or the usual and customary charge, whichever is less.
