Bariatric Surgery - MEDICAID - LOUISIANA

This policy covers bariatric surgery for Humana Healthy Horizons® Medicaid members in Louisiana, including adults with BMI ≥40 kg/m2 (or >100 lb overweight), adults with BMI ≥35 kg/m2 with one or more obesity-related comorbidities (such as type 2 diabetes, cardiovascular disease, or obstructive sleep apnea), adults with BMI 30–34.9 kg/m2 with inadequately controlled type 2 diabetes, and selected adolescents (ages 13–17) meeting pediatric BMI and comorbidity thresholds. Coverage requires a multidisciplinary preoperative evaluation within 12 months (physician, nutritionist/dietitian, and licensed mental health professional with pediatric expertise for minors), documentation of unsuccessful prior weight‑loss attempts and ability to adhere to postoperative care, pregnancy‑avoidance counseling for those who can become pregnant for ≥12 months postoperatively, and specific diagnostic confirmations (e.g., polysomnography criteria for OSA); all listed criteria must be met.