Gastric Sleeve Centers. Does Humana Cover Gastric Sleeve Surgery? Humana Health Insurance of Northern and Southern California will cover your Gastric Sleeve Surgery as long as your insurance plan's requirements for bariatric surgery are met. Humana Gastric Sleeve Coverage. Humana Gastric Sleeve Requirements.
Be it plastic surgery, or a revision, the sheer numbers of post-op patients is increasing the demand for these two types of post-op procedures. A patient will be dealing with either a revision of a failed bariatric procedure or a revision to a new type of procedure not approved or even in existence at the time of the original surgery. To begin, a request for a revision based upon a failed prior bariatric surgery is going to immediately invoke a response from most insurance providers questioning whether the prior surgery actually failed, or the patient was simply not compliant with the requirements of the first surgery. Before you make this type of request, it is imperative that you and your surgeon are on the same page. He or she should be aware of the exact need for the surgery, as well as your compliance issues during the original procedure. Never wait for the insurance company to ask the question. Answer it when your surgeon submits the request for authorization. In this case, you are going to make sure that the carrier knows that if the revision is not granted, it will only be a short matter of time before your BMI climbs even higher and your co-morbidities return. If your request involves a new type of surgery, perhaps one that didn’t exist when you had your original surgery, make sure the reasons why this surgery is right for you are included in the request for surgery. And second, that this is a request to correct a failed procedure that may cause significant problems in the near future and as such it is not for obesity or weight-loss.
UW Health Medical and Surgical Weight Management surgeons perform the Roux-en-Y gastric bypass, laparoscopic adjustable gastric band and sleeve gastrectomy procedures as well as revisional surgery for people who have had previous weight loss surgery. The following is basic insurance information regarding bariatric surgery. Please note that coverage varies widely, each employer may purchase a different plan and the information below may not apply to your individual plan. Please call your insurer or employer's benefits department for the most current and accurate information regarding coverage and requirements of your plan. We recommend that you call the customer service number on the back of your insurance card. Provide your ID number and ask if bariatric surgery is a covered benefit and what requirements for surgery are specified by your plan. Once you have started with our program, we will ask for a copy of your insurance card and will call to verify your benefits and confirm that our facility is in network under your plan. Will my insurance cover the costs associated with surgery? Depending on your insurance plan, the supervised diet may be done with your primary care provider or a registered dietitian; some structured programs (such as Weight Watchers or Jenny Craig) may also be acceptable. The UW Health Medical and Surgical Weight Management Program offers self-pay packages for gastric bypass (Roux-en-Y), sleeve gastrectomy and adjustable gastric band procedures. Please contact our program to discuss whether this may be an option for you and for pricing information. Medicaid/Badgercare offers the gastric bypass, sleeve gastrectomy and adjustable gastric band procedures to beneficiaries with a BMI greater than 40 with at least one severe medical condition (such as uncontrolled diabetes, hypertension, heart disease or obstructive sleep apnea).
If bariatric surgery costs are covered by your insurance plan, the next step is to find out the patient criteria and medical requirements for the procedure. Insurance companies often follow the National Institutes of Health (NIH) guidelines in determining whether or not a patient should be considered eligible for weight loss surgery coverage. Since weight loss surgery is considered the last method of treatment for obesity, you will need to provide documentation to the insurance company of previous weight loss attempts. Pull together your receipts and weight loss records and send copies to the insurance company. Establish a Medical Necessity for Weight Loss Surgery. In order to verify that you meet the patient criteria for weight loss surgery, your primary care doctor and/or bariatric surgeon will need to send a Letter of Medical Necessity to the insurance company. The Letter of Medical Necessity is a statement of your height, weight, BMI, health conditions, medical records, previous weight loss attempts, psychological exam results, medical necessity for weight loss, and your doctor's support and recommendation for bariatric surgery. Appealing Denials for Weight Loss Surgery. If your insurance plan has an exclusion for weight loss surgery, it may still be possible to get approval of your obesity co-morbidities.
UPMC | Affiliated with the University of Pittsburgh Schools of the Health Sciences. For help in finding a doctor or health service that suits your needs, call the UPMC Referral Service at 412-647-UPMC (8762) or 1-800-533-UPMC (8762). You should not rely entirely on this information for your health care needs. For UPMC Mercy Patients: As a Catholic hospital, UPMC Mercy abides by the Ethical and Religious Directives for Catholic Health Care Services, as determined by the United States Conference of Catholic Bishops. As such, UPMC Mercy neither endorses nor provides medical practices and/or procedures that contradict the moral teachings of the Roman Catholic Church.
Bariatric surgery is covered by many insurance policies, and the amount which it costs depends upon the type of policy and its terms, as well as any contractual arrangement with the hospital. If you wish to contact us for evaluation and surgery, we perform the insurance authorization and approval process without charge. The actual rate varies, depending on the type of surgery chosen, and initial weight and health status. Indemnity Insurance policies (the type where they pay 80% and you pay 20%) will often cover surgery for medically necessary treatment of clinically severe obesity. The key to dealing with these organizations is that they usually do not specifically exclude coverage in their contract, and if it can be shown that treatment is medically necessary to preserve life or health, they will have to provide it. Medi Cal does not cover this type of surgery, and does not pay the surgeon who performs it. As you may have noticed above, the need for surgery, and the coverage by insurance, usually depends upon the determination that surgery is medically necessary to improve health, to reduce risks to life, and to permit a normal lifestyle. Once the indications for surgery have been evaluated, and needed testing is accomplished, a request can be made for the health care benefits. We will prepare and submit a letter to your insurance carrier, requesting certification of your insurance coverage, and authorization for you to proceed with surgery, with our surgeons and facilities. This letter will be detailed and specific, stating each of your indications, and the corroborating information. HMO's and the like will not accept a letter or request from us directly, nor will we be able to order diagnostic testing for you. Your HMO will want to refer you to a contracted surgeon - be sure that this is a surgeon with current experience and competence in bariatric surgery, operating in a comprehensive surgical weight control program, as recommended by the NIH Consensus Panel. California Medi CAL patients will find the initial response discouraging, and we have found that the Medi CAL program consistently denies payment of surgical fees for bariatric surgery - we do not offer the procedure under the Medi CAL program. For information on legal assistance, you may want to check with the Obesity Law and Advocacy Center .
That's especially the case in the Deep South, where obesity rates are among the highest in the nation, and states will not require health plans sold on the new online insurance marketplaces to cover medical weight loss treatments like prescription drugs and bariatric surgery. That long-standing food culture, as well as other factors like inactivity and poverty, have saddled Mississippi with the highest obesity rate in the nation. After surgery, many of the complications of obesity, like sleep apnea and high blood pressure, are reversed. Medicare and about two-thirds of large employers cover bariatric surgery in the U. "Our hope was that there would be a single benefit for the entire country, and as part of that benefit there would be coverage for obesity treatment," says Dr. He is director of bariatric surgery at Stanford University Morton, and has led national and state lobbying efforts to get insurance coverage for the surgery. That's led to an odd twist: In more than two dozen states, obesity treatments – including intensive weight loss counseling, drugs and surgery – won't be covered in plans sold on the exchanges. Bariatric surgery won't be covered on the exchanges in Alabama, Louisiana, Arkansas, Texas and Mississippi. That's where, according to the Centers for Disease Control, obesity rates are among the highest . Therese Hanna, Executive Director of the Center for Mississippi Health Policy , isn't surprised that obesity treatments are excluded on the insurance exchange in her state. The discussion in Mississippi, she says, has focused on providing care for things like high blood pressure, diabetes and heart disease. And for people who are suffering from severe obesity, weight-loss surgery is often considered the most effective treatment. Nowhere is obesity more prevalent than in the state of Mississippi. But a quirk in the Affordable Care Act means Mississippi and other Southern states will not be covering weight-loss surgery in the new insurance marketplaces called Exchanges. And so they're really not associating the two.
Does United Healthcare Cover Gastric Sleeve Surgery? United Health Care of California will cover your Gastric Sleeve Surgery as long as your insurance plan's requirements for bariatric surgery are met. Each United Healthcare California insurance policy can vary on what weight management or bariatric and gastric surgery expenses are covered or excluded, so it may be easier to have our Gastric Sleeve Insurance Coordinators verify your United Healthcare Gastric Sleeve Surgery coverage for you. United Healthcare Gastric Sleeve Coverage. Every person is different, and so is each insurance plan; United Healthcare of California’s Gastric Sleeve Coverage and pre-approval requirements vary with every insurance policy and potential patient. If Your BMI is below 40, United Healthcare will also consider all medical issues and problems related to your weight prior to authorizing coverage of your Gastric Sleeve Surgery. United Healthcare Gastric Sleeve Requirements. You may automatically pre-qualify for United Healthcare Gastric Sleeve Surgery Coverage if: To see if your United Healthcare Insurance Plan covers the Gastric Sleeve Surgery, please call us at 1-855-690-0559, or fill out our FREE Gastric Sleeve Insurance Verification Form and we will verify your United Healthcare coverage for you!
If the surgery is excluded, there's nothing you can do, even if it's medically necessary. This can be appealed by your doctor; if the insurer upholds its denial, it can be appealed to the VA Insurance Department. Insurance coverage for morbid obesity surgery varies according to the insurance carrier, and those that cover bariatric surgery often limit their coverage to certain types of surgery. Many insurance carriers only cover gastric bypass surgery. • Call your insurance carrier and make sure your plan provides coverage for weight loss surgery, and that you have covered benefits for morbid obesity surgery. Keep in mind that although you may have completed all the necessary steps in order to schedule surgery, your insurance plan may not authorize it. • Your insurance carrier may request the name of the surgery and the CPT/ICD-9 codes. • Your call to the insurance company should be for informational purposes only. You will receive your surgery date after you have met with the surgeon. • Once you have a scheduled surgery date, it may take another two weeks to two months to obtaining approval from your insurance carrier. You can only upload photos smaller than 5 MB. You can only upload videos smaller than 600 MB. You can only upload a photo or a video.
Weight loss surgery is generally not covered for cosmetic reasons to improve the appearance of the member, but may be covered subject to the indications listed below. Weight loss surgery is covered when the member has been evaluated and treated by an in-network designated weight loss surgical physician and all of the following are met: All candidates for weight loss surgery must have completed all of the following: Evaluation by a surgical team in the Health Partners Weight Loss Surgery network. Documented qualifying BMI AND with at least 5 completed sessions with Health Partners’ Weight loss surgery program phone course. Weight Loss Surgery Procedures that are covered when the above criteria are met: Conditions for which weight loss surgery is not covered: Conditions for which weight loss surgery (and/or any procedures generally used for weight loss surgery) is not covered. Because of these multiple factors, weight loss surgery is not considered to be the first or only treatment for obesity. Weight loss surgery is not an alternative to a diet and exercise management program. The RYGBP achieves weight loss by gastric restriction and malabsorption. BPD achieves weight loss by gastric restriction and malabsorption. Two examples of this procedure that are proposed for revisions of standard weight loss surgery are Stomaphyx and the ROSE procedure (restorative obesity surgery – endoluminal).
How to get your health insurer to pay for your weight-loss surgery. Even with your doctor’s recommendation and coverage available from your health insurance policy, your health insurer might not pay for the surgery. If you’re considering bariatric surgery and want your health insurance to pay for it, you may have to jump through a few hoops. It's common to find health insurance companies that will not pay for weight-loss surgery, yet these same insurers are paying for years of treating the conditions associated with obesity. Your best chance for attaining insurance coverage for weight-loss surgery is through a group health plan. The American Society for Metabolic and Bariatric Surgery certifies "Centers of Excellence" around the country. For Aetna plans that do cover bariatric surgery, here is a summary of the criteria for gastric bypass approval: Bariatric surgery is specifically excluded under the standard CIGNA Health Care plan, but employers can elect to include or exclude coverage for bariatric surgery in their group health plans. CIGNA Health Care also covers medically necessary reversal for bariatric surgery when a patient has complications and, under certain circumstances, covers revision of a previous bariatric procedure when the patient has not lost adequate weight. At best, you'll need mounds of documentation to show the surgery is medically necessary for you. Hutcher compares submitting a claim for bariatric surgery to playing roulette: "And in roulette, you know the house always wins," he says. So why do health insurers seem to fail to see the cost-effectiveness in paying for surgery versus paying for years and years of treating related conditions? You will probably need to provide further documentation of your need for the surgery as medically necessary.
TRICARE covers the following open or laparoscopic bariatric surgical procedures: All of the following conditions must be met to qualify: You were unsuccessful with non-surgical medical treatments for obesity. Diet programs, such as Weight Watchers®* and Jenny Craig*, are acceptable methods of dietary management, as long as there are monthly clinical visits with your doctor and medical documentation of your participation and your progress throughout the course of the dietary program. *These programs are not covered by TRICARE. You have proof of one of the following: TRICARE doesn't cover the following services: Office visits solely for the treatment of obesity. Non-surgical procedures for treatment of obesity. TRICARE covers services that are medically necessary and considered proven.
Insurance coverage for the Lap Band procedure. Insurance coverage for the Lap Band surgical procedure is determined on a person-by-person basis. You may also see if you can get partial coverage for the LAP BAND System surgery. The first step is to check your "certificate of coverage" for benefits or exclusions of lap band surgery. Check the Patient Criteria and Medical Requirements for Lap Band Surgery. If lap band surgery costs are covered by your insurance plan, the next step is to find out the patient criteria and medical requirements for the procedure. Since weight loss surgery is considered the last method of treatment for obesity, you will need to provide documentation to the insurance company of previous weight loss attempts. In order to verify that you meet the patient criteria for lap band surgery, your primary care doctor and/or bariatric surgeon will need to send a Letter of Medical Necessity to the insurance company. Many lap band patients have been successful in the appeals process, but you should be prepared to be diligent in meeting the insurance company's requirements and pressing for lap band surgery coverage. If your insurance plan has an exclusion for weight loss surgery, it may still be possible to get approval if you obesity co-morbidities.
As a result, many insurers now cover all or some of the costs associated with gastric sleeve surgery . Insurance coverage for gastric sleeve surgery varies by state and insurance provider. Gastric Sleeve Insurance Coverage: What Is Covered? Insurance coverage for gastric sleeve surgery tends to be similar in scope to coverage of other bariatric surgeries. Some insurers may pay the entire bill, but others only pay 80 percent of what is considered "usual and customary" for gastric sleeve surgery. If you are considering gastric sleeve surgery, contact your insurance plan to find out if the procedure is covered, and what such coverage entails. Gastric sleeve insurance coverage may include the program elements that are necessary to be successful with your procedure such as support groups, exercise and nutrition counseling. Some people may not lose enough weight with the gastric sleeve surgery alone and may need a secondary procedure such as duodenal switch or gastric bypass surgery . Insurance carriers cover the cost of gastric sleeve surgery if you meet certain pre-specified criteria, which vary by company. United Healthcare will cover the cost of gastric sleeve surgery for individuals with a BMI of 40 or higher, or a BMI 35 to 39.9 and one obesity-related illness. If a person has severe heart and lung problems associated with obesity, however, they may lower the BMI requirement and cover the costs of gastric sleeve surgery. Gastric Sleeve Insurance Coverage: Action Points. Gastric Sleeve Insurance Coverage: Other Options. If you choose to pay cash for gastric sleeve surgery, complications may not be covered. Some bariatric surgery centers may offer "reinsurance" plans that will cover the cost of complications during the first year after surgery if you pay cash for your gastric sleeve surgery.
Each insurance company has its own criteria for bariatric surgery, and policies change frequently. First we will prepare a letter to establish the "medical necessity" of weight loss surgery and obtain pre-authorization from your insurance company. Lastly, we will need a letter from your general physician diagnosing you as morbidly obese and stating that you are a candidate for bariatric surgery. Your physician should also state that he or she has supervised you in diet and exercise attempts that have not significantly helped. We won’t take no for an answer, if you have the benefit and meet criteria. You may have to change policies, if this is an option, during open enrollment from the HMO to the PPO, although there is no guarantee that the other policy will cover obesity surgery. You may have to finance or privately pay the surgery (please call our office for details). Coverage depends on what type of policy you have and the terms within the policy. Your employer and the insurance company determine the benefits available to you.
The only way you can know is call the number on the back of your card and ask a rep if your policy covers it. By and large the surgery is safe, although you can die and have serious consequences such as dumping syndrome, gall bladder problems, ulcers, or chronic vitamin or mineral deficiencies for the rest of your life. But you have to diet regardless of having the bypass for the rest of your life.) Gastric bypass is not that dangerous is you follow the rules, and it isn't a quick fix. Make sure to regularly check up with your doctor so she can chart how successful you are. If you have not succeeded in losing weight, talk with your doctor about surgery. In most cases, for the surgery to be covered, a doctor has to state that normal methods of weight loss don't work. I'm sure you have heard this before ~ but it really is important to start changing your eating/exercising habits *now* before the surgery. That means, IF you survive, there's an 85% chance after five years, you'll be back or above your pre surgery weight. You can only upload photos smaller than 5 MB. You can only upload videos smaller than 600 MB. You can only upload a photo or a video.
But when you have a lot of weight to lose, and if exercise and diet aren't enough, you might consider weight loss surgery , also called bariatric surgery . You'll probably have questions about how much it costs, what insurance covers, and how to convince your insurance to cover the bill. Weight Loss and Health Care Reform. Weight loss surgery is expensive. The price of your weight loss surgery will depend on several factors: This will vary based on where you live, your surgeon's expertise, and the procedure’s complexity. Costs will vary and may include the operating and hospital rooms, among other fees. If you don’t have health insurance, you’ll likely have to pay the entire bill yourself. Some weight loss surgery centers can help you get a loan that you can repay over a number of years.
Health Insurance Will Cover Obesity Treatment in 2015. In an exciting new development, many Americans will soon have the option to switch to a health care plan that does cover obesity treatment—including bariatric surgery, weight loss programs and nutritional counseling—under the Affordable Care Act, commonly known as “Obama Care.” (See our table below for state-by-state details.) While not every state has agreed to incorporate obesity treatment into their marketplace health plans yet, this is a significant step in the right direction and we encourage you to review your options. All enrollment closes on February 15, 2015, after which you will no longer be able to sign up for a health plan in or out of the Health Insurance Marketplace for the rest of 2015. Consult the table below to see which obesity treatments your state includes. If you live in a state that does not offer coverage for weight loss treatment in the Health Insurance Marketplace, there may be private insurance providers in your area that do. Whether or not you can obtain a plan that covers weight loss treatment options, NOF can assist you in finding an accredited bariatric surgeon in your area that best suits your needs. Obesity Treatment Options Under the Affordable Care Act by State.
Gastric bypass surgery can cost anywhere from $18,000 to $22,000. Gastric Bypass Insurance Coverage: Overview. Insurance coverage for gastric bypass surgery varies by state, employer and insurance provider. "Usual" refers to the normal rate charged for gastric bypass, and "customary" refers to the rates charged by providers in your area. Some insurance companies or employers may also require a co-payment for gastric bypass surgery. Most insurers who cover gastric bypass surgery will pay for all or some of the costs associated with anesthesia, the hospital facility and the surgeon's fee. There is no pre-certification or pre-authorization needed for Medicare coverage of gastric bypass, but Medicare does not decide on eligibility until after you have had the surgery. Medicaid and Gastric Bypass Surgery. Contact your state's Medicaid office to see what policies are in place regarding coverage for gastric bypass surgery. Private Insurance and Gastric Bypass Coverage. Different companies have different requirements for gastric bypass coverage. Gastric bypass surgery is usually not covered for individuals who work for small companies with less than 100 employees. Your gastric bypass surgery will not be scheduled until you receive this authorization. You may choose to pay out of pocket for gastric bypass surgery. Some centers have "reinsurance" plans that you can buy into for coverage of any complications that may occur during the first year after gastric bypass surgery.
What bariatric surgery procedures are covered? May I have a copy of the Medical Policy statement for bariatric surgery insurance coverage? What is the annual deductible, if any, and how much have I met so far? Here’s how: Let’s say you have already met $875 of your $1,000 annual deductible, and your insurance plan year begins (renews) on August 1. If you have surgery on August 2, you would again be responsible for the $1,000 deductible amount, instead of the remaining $125 from the previous year. Every year we see a heightened interest in bariatric surgery in November or December because people have met their deductible and want surgery before the new year when their insurance renews. People who are considering weight loss surgery and want to take advantage of the lower insurance deductible should start the process early enough to ensure that they can get surgery by the new calendar year. It is a way to make sure the procedure is covered under your Bariatric Surgery Insurance policy. What are some of the most common bariatric insurance coverage requirements? Some of the most common bariatric insurance coverage requirements include: What if my insurance provider denies the coverage? The surgeon’s office will be notified of the denial of coverage and will assist with you the appeal process if you choose to appeal.
Aetna, one of the nations largest health insurers, revised its policy on obesity surgery this month to include open and laparoscopic sleeve gastrectomy among its covered bariatric procedures. The sleeve gastrectomy procedure, often referred to as the gastric sleeve, is a newer method of bariatric surgery that is gaining in popularity as a treatment for morbid obesity. Prior to the policy change, Aetna considered the sleeve gastrectomy ‘investigational’ and did not cover the surgery. As of 4/9/2010, Aetna revised its Clinical Policy Bulletin for Obesity Surgery and stated that the “sleeve gastrectomy is considered medically necessary when criteria are met.” Although the sleeve gastrectomy is included under bariatric procedures, coverage for obesity surgery is still dependent on benefit plan details and approval by Aetna. The decision of Aetna and United Healthcare to cover gastric sleeve will benefits patients who are morbidly obese and considering weight loss surgery.
Would you like to make it the primary and merge this question into it? Gastric bypass surgery makes the stomach smaller and causes food to bypass part of the small intestine. • The surgery is medically necessary. Bariatric surgery is not a benefit when the primary purpose of the surgery is any of the following:• For weight loss for its own sake. Behavioral health services provided as part of the preoperative or postoperative phase of bariatric surgery are subject to behavioral health guidelines and are not considered part of the bariatric surgery. Doctors have found that most people have great success with just the first part of the surgery performed, and so it is gaining in popularity. With the gastric sleeve surgery, the stomach is drastically reduced, to about 25 percent of its original size. Because food is digested in the stomach, this is not as severe with gastric sleeve surgery. In many people's minds, the main purpose for any bariatric surgery is to improve the chances of morbidity in the morbidly obese, and certainly this type of surgery achieves that. This is even more the case with anyone having bariatric surgery, because obesity is a risk factor in complications from surgery. Ultimately, I think it may depend on your contract with them and the coverage you pay for. Gastric bypass is poses the serious risk of infections and inflamation.
Insurance coverage and the cost of weight loss surgery are perhaps one of the greatest concerns for patients who consider surgical weight loss. Patel he will review whether or not you have the benefit of weight loss surgery, what your benefit plan requires you to do to prove medical necessity, and what your out-of-pocket expense will be if you pursue surgery. Dealing with an exclusion in your insurance regarding weight loss surgery; Additionally things in the insurance environment and with your employer’s policies change constantly and Dr. One should never consider it a waste of time to visit with the surgeon and to be initiated into a program for your overall well-being even if the insurance company says no. You will then be assigned a unique username and password which will allow you to access our database online from any computer in the world in order to evaluate where you are in your insurance authorization process. This is unique to any program in South Texas, where you can have a moment-by-moment update in regards to your progress through a tedious insurance verification process and authorization process. The assignment of advocate is based upon your insurance and the timeline which you are going to be able to achieve surgery and where you are going to pursue your physician supervised program. Patel regarding your weight loss surgery insurance benefit and your out-of-pocket expenses, and a timeline within which your surgery should be able to be approved are not being met by your standards, you are encouraged to email Dr. The Insurance process for your weight loss surgery can be a very stressful process. Call your insurance company for you and verify if your company offers the benefit. Walks you ‘step-by-step through all the things that the insurance company will require to do if coverage is available. Will my insurance pay for my surgery? Many insurers will cover your weight loss surgery, however it is difficult to achieve insurance authorization on your own. Does Insurance Cover Weight Loss Surgery?
Getting your insurance company to cover your weight loss surgery can be easy, or it can be difficult. It might help to think of your insurance policy as a product, that your employer has purchased. So the first question is, does your policy "cover" or "have benefits for" bariatric surgery? That brings us to the next question, which depends on you, and whether or not you meet the criteria that are set forth in your policy. Below we'll provide some tips that might help you to help yourself in obtaining insurance coverage for your weight loss surgery. Here are some tips that might help you when dealing with your insurance company and considering your insurance coverage: Check out your insurance policy. Call your insurance company. You can help by calling your insurance company. Write down the name and phone number of the person you speak with at your insurance company so that our staff can follow up on the information they give you. This will assist us with a preliminary insurance verification check and verification of any co-pays and deductibles that are in your policy. If your insurance requires, you will need to get a referral from your primary care physician. Well Star Comprehensive Bariatric Services does not guarantee that your insurance company will approve you for surgery. We will aggressively pursue getting approval once you become a patient of ours, but ultimately the decision lies with your insurance company. If your insurance policy has exclusions or denies you, meaning it will not cover this type of procedure, you have a right to appeal this.
This is an important issue that you will need to investigate. It is mostly employer driven; in other words, the company you work for who provides the insurance decides whether or not you have surgical weight loss (Lap Band, Realize Band, gastric bypass, or sleeve gastrectomy) benefits. We have an insurance team consisting of 3 full time professionals that have unsurpassed expertise to help you get your procedure approved! You will need to call your benefit administrator (the number is usually listed on the back of your card) and ask them if you have surgical weight loss benefits. I don't have surgical weight loss benefits but my family doctor said he would write me a letter and get it approved, will that work? If you have a policy exclusion this means that your insurance will not cover surgical weight loss even if the president of the United States writes you a letter. Your insurance company is not saying you don't need the operation, they are saying that your policy does not provide benefits to cover it, just as your fire insurance policy will not cover flood damage.
Weight Loss Procedures and Surgeries. 50% excess weight loss. BMI over 40, notwithstanding the 50% excess weight loss. Weight loss surgery procedures should only be performed on individuals for whom regular diet, exercise and medication didn't prove effective. Weight Loss Procedures and Surgeries Q&As.
Does United Health Care cover gastric bypass surgery, and if so are there any special requirements or steps that should be taken. Subject: Re: Does United Health Care cover Gastric Bypass Surgery? There's different plans and different levels of coverage, but in general, if you meet the criteria, UHC DOES cover gastric bypass surgery. The Question is: Will my insurance cover this procedure? Below is a list of insurances that we have found that cover gastric bypass procedure. Every insurance company will have its own medical criteria you must meet before they approve gastric bypass surgery: United Health Care IS on the list.
United Healthcare (UHC), one of the largest health carriers in the United States, has changed its bariatric medical policy to include coverage for gastric sleeve surgery. The new policy, which went into effect October 1, 2009, is a significant event for bariatric surgery patients and gastric sleeve advocates. This recognition makes United Healthcare the first major insurer to cover the gastric sleeve as a complete bariatric surgical option. UHC’s coverage for the gastric sleeve will be the same as for the other bariatric procedures that they cover. Traditionally, the gastric sleeve was only performed as the first stage of the duodenal switch surgery. Some bariatric surgeons are even suggesting that the gastric sleeve has the potential to surpass the popularity of gastric bypass surgery and laparoscopic adjustable gastric banding.
(See bariatric surgery qualifications from the NIH, which insurance companies often reference.) Some insurance companies have a mandatory three-month weight management protocol that patients must complete before surgery. Medicare covers some bariatric surgical procedures if the patient meets certain conditions related to morbid obesity.
United Healthcare (UHC), one of the largest health carriers in the United States, has changed its bariatric medical policy to include coverage for gastric sleeve surgery. The new policy, which went into effect October 1, 2009, is a significant event for bariatric surgery patients and gastric sleeve advocates. This recognition makes United Healthcare the first major insurer to cover the gastric sleeve as a complete bariatric surgical option. UHC’s coverage for the gastric sleeve will be the same as for the other bariatric procedures that they cover. Some bariatric surgeons are even suggesting that the gastric sleeve has the potential to surpass the popularity of gastric bypass surgery and laparoscopic adjustable gastric banding.
Home » The Process » Insurance and Payment Options. New Jersey Bariatric Center® accepts most insurances but bariatric coverage for each individual policy varies by company and employer. To avoid misunderstandings regarding your health benefits, we recommend you work with New Jersey Bariatric Center’s patient navigators to determine your exact coverage. We are able to work with many insurance companies to authorize and pay for most of the hospital charges and surgeon fees. Our preference is for you to use your insurance to avoid the significant hospital and other related costs. If your health insurance doesn’t fully cover the cost of bariatric surgery, doesn’t authorize the procedures or if you don’t have health insurance, New Jersey Bariatric Center® participates with Care Credit®, a GE Money company.
Having medical insurance doesn't mean you won't need to pay for all or part of the procedure yourself. This article will help you learn more about insurance and paying for gastric bypass surgery . Whether or not the procedure and related costs are covered by health insurance depends on your insurance company, your state, and your specific policy, among other factors. Some insurance plans explicitly exclude obesity treatment, weight loss surgery and related care, which means that they will not cover any related charges you may incur from preparing for, having, or recovering from your gastric bypass procedure . Once you have seen the specialist and have been deemed a candidate for weight loss surgery , you will need to begin the pre-authorization process. It is likely that your insurance company will request both your physician and your surgeon send in something called a "letter of medical necessity" as part of the weight loss surgery pre-authorization process. Basically, your doctors will relate to the insurance company how having the procedure will improve your health and overall well-being. At this point, your request for authorization will be approved, denied, or the insurance company will request additional information. If you are denied pre-authorization by your insurance company, you can appeal the decision. The process usually begins with a letter of appeal being sent in to the insurance company by you, your surgeon and your primary care provider. If you are on Medicare , a portion of the costs of gastric bypass surgery and related care may be covered, but only if you are both obese and suffer from an obesity-related disease such as type 2 diabetes or coronary heart disease . If you do not have health insurance, or, your insurance does not cover weight loss surgery, you will need to cover your costs yourself. Another option is to pursue private financing from a lender for your medical expenses, but as with any other type of personal loan, you will need to consider the finance charges (interest rate) and fees.