UM/Aetna members (employees only) are eligible for coverage of bariatric surgery.

Employee Eligibility

• The patient is a University of Miami employee covered by the University of Miami/Aetna health plan.
• The patient/University of Miami employee has completed five years of continuous, current service to the University of Miami at the time of the request or the patient is a former employee of the University of Miami/UMH on UM/Aetna COBRA but met the five year continuous service requirement prior to COBRA coverage.
• For University of Miami Hospital employees, years of service includes continuous service to University of Miami Hospital and Cedars/HCA.

Provider Requirement

Surgical procedure is performed at University of Miami Hospital by the UM Division of Bariatric Surgery.

Clinical Requirement

The employee will only be covered if they meet application of Aetna clinical criteria.

UMH is a member of the Aetna Institutes of Quality ("IOQ") for Bariatric Surgery. Facilities in this notable network must meet the following criteria:

• Have significant experience in bariatric surgery, including a minimum of 125 procedures in the most recent calendar year
• Evidence-based and recognized standards for clinical outcomes, processes of care and patient safety
• Provide on-going follow-up programs and support for their bariatric surgery patients
• Adhere to Aetna's standards for member access to the facility and Aetna participating providers
• Demonstrate efficiency in providing care based on overall cost of care, readmission rates and comprehensiveness of program

For additional information on bariatric surgery, please contact 305-856-4385.