SurgeryPlus (Surgeons of Excellence)
Announcement
The SurgeryPlus benefit is a comprehensive surgical program that provides a personalized concierge experience from dedicated Care Advocates and access to excellent health care through a network of credentialed Surgeons of Excellence for planned, non-emergent surgeries. Enrollment in the SurgeryPlus benefit is automatic for individuals enrolled in a State of Delaware Aetna or Highmark Delaware non-Medicare health plan.
Their goal, in partnership with the State of Delaware, is to simplify the surgical process from start to finish - from helping schedule appointments to eliminating medical bills related to your care. The credentialed surgeons undergo a rigorous evaluation process to assure that you receive high-quality care from specialists who excel in the area related to your needs. SurgeryPlus negotiates a single cost (bundled rate) for the entire surgical procedure, resulting in savings for the State of Delaware.
Using the SurgeryPlus benefit for your planned, non-emergent surgeries saves you money by reducing your financial responsibility and removing deductibles, copays and coinsurance amounts. Some surgeries and procedures may even include a financial incentive and travel benefits, when applicable.
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BARIATRIC SURGERY
Effective July 1, 2023, all bariatric surgeries will be required to be completed through the SurgeryPlus benefit and performed by a surgeon in the SurgeryPlus network. The requirements needed for surgery, including any pre-operative tests, screenings, evaluations, and post-operative care will continue to be covered under your Aetna or Highmark Delaware non-Medicare health plan. The surgery and any facility costs will be 100% covered under your SurgeryPlus benefit. Pre-authorization will still need to be submitted by your provider to SurgeryPlus before the surgery is scheduled. Members will pay nothing out of pocket for bariatric surgery; however, financial incentives do not apply.
Please note: If you are covered under the State of Delaware Group Health Insurance Plan as secondary, refer to the SurgeryPlus plan booklet for details on bariatric coverage.
