The process leading up to bariatric surgery varies depending on each person’s medical history and insurance requirements. Please review the process below for additional information.
Once insurance review is complete, a member of our staff will contact you to set up an appointment for an evaluation. When you attend a seminar at our facility, you will have the opportunity to speak with any number of our Bariatric Staff, including the surgeon, dietitian, nurses, and insurance coordinator(s).
The evaluation appointment is scheduled for about two weeks after we call you. It’s a group meeting with a nurse, dietitian, surgeon and insurance specialist. You’ll also have a one-on-one meeting with the physician assistant for an initial history and physical. After that visit, you will be scheduled for:
By using the Insurance Review Form in the Patient Profile Packet, you will know if your policy has benefits for weight loss surgery. If it does and you want to proceed, send in your Patient Profile Packet and the Insurance Review Form. We will screen your health history to make sure you are an appropriate candidate and our Insurance Team will make sure you meet the criteria set forth by your insurance policy. Assuming you meet all criteria, we will call to schedule your first appointment, where you will receive a personalized benefits form that will estimate, to the best of our abilities, your total out-of-pocket expenses. You will also need to complete a seminar in person at our facility or online.
Most insurance plans require that your BMI be 40 or higher. However, if your BMI is between 35 – 39.9, we can sometimes get you approved if you have a life-threatening medical condition, such as high blood pressure, diabetes or sleep apnea.
For commercial insurance policies; Contact the customer service number on the back of your insurance card and ask this question exactly. “In my certificate of coverage are there benefits for weight loss surgery for morbid obesity if medically necessary?”
For Medicare and Medicaid; there are benefits for weight loss surgery as long as the criteria is met. There is no need to contact Medicare and Medicaid.
Most insurance companies that require a diet still require the diet no matter how many co-morbid diagnoses you have.
YES… the diet is part of criteria set by your insurance company. Your physician can write you a letter of support which will assist in obtaining approval, but you still have to complete the diet.
This is a question that is asked a lot… sometimes additional testing is required, one primary care may get the documentation back faster, or if your friend has a different insurance than you, maybe you were required to do a diet and your friend was not. If the insurances are different, then it may be because one insurance just takes longer to process than the other.
Usually the diet must be for at least 6 full months, which is one initial visit and 6 follow-up visits. Your appointments must be consecutive and the diet must be successful, meaning your end weight must be the same or less than your start weight.
This means that your particular plan does not have benefits for weight loss surgery, no matter if you meet the medical necessity requirements or not. Your insurance may tell you that you have appeal rights, keep in mind that you will be appealing policy and not medical necessity. If there are no benefits for weight loss surgery it basically means that the benefit was not purchased by your company.
We do offer bariatric surgery for patients who would like to pay out-of-pocket. Please contact us directly for a quote.
Many patients are able to stop using some medications such as those for diabetes or high blood-pressure if these health issues are directly related to their weight. It is recommended that bariatric surgery patients maintain a vitamin regiment indefinitely after their procedure.