Bariatric Case Management - Washington State Local Health Insurance - CHPW
Community Health Plan of Washington Apple Health Medicaid Plan Community Health Plan of Washington Apple Health Medicaid Plan

Bariatric Case Management

Is bariatric surgery right for you?

As a Community Health Plan of Washington (CHPW) member, you may wish to explore bariatric surgery to improve your health and comfort. CHPW has a 3-phase program to help you assess whether this surgery is right for you.

Any CHPW member can ask to participate in the Bariatric Case Management Program. All members who participate will be enrolled in case management. Our case management team will provide individual support, answer your questions, and help you coordinate care through this process.

Stage 1 – Assessment

When you ask your primary care provider about bariatric surgery or CHPW’s Bariatric Case Management Program, they will perform an assessment. You don’t need a referral or prior authorization to start Stage 1.

Your doctor will assess:
  • Obesity-related medical conditions like high blood pressure, type 2 diabetes, and sleep apnea
  • Whether you have tried to lose weight in other ways, but haven’t been able to

Before starting Stage 2, you must get prior authorization from CHPW. Your provider will submit the request.

Stage 2 – Evaluation and weight loss

Stage 2 is six months long. It has two parts: a weight loss program and a detailed evaluation by an approved provider. CHPW case managers will help you arrange the care you need and coordinate between your providers and CHPW.

As part of Stage 2, you’ll participate in a weight loss program with these elements:
  • Following a weight loss plan under the supervision of a licensed medical provider, with sustained weight loss of at least 5% of body weight
  • Meeting with a health care provider once monthly to review progress
  • Meeting with a dietician for counseling twice monthly for at least 6 months
  • Keeping a journal of your participation in the weight loss regimen

You’ll also undergo a detailed evaluation to make sure you don’t have substance abuse problems or psychiatric illness that would keep you from participating in pre-surgery diet requirements or post-surgery lifestyle changes.

The evaluation must include:

  • Documentation that if you have a history of psychiatric illness, you’ve been stable for at least 6 months
  • Documentation that if you have a history of drug and alcohol abuse, you’ve been sober for at least one year
  • An internal medicine evaluation to assess your condition and the health risks of surgery
  • A surgical evaluation by the surgeon who will be performing the bariatric surgery

Stage 3 – Surgery

After you complete Stage 2, you will be eligible to get bariatric surgery. You must obtain prior authorization from CHPW before the surgery.

CHPW case managers will help you schedule your surgery, offer support, and help you make a plan for after discharge.

Are you wondering if bariatric surgery is right for you?

Call us to learn more about the Bariatric Case Management Program at 1-866-418-7004.


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