What will insurane pay for after weight loss surgery. Now the there can be a lot more to a Trupanion pet insurance review but since every pet owners will always pay the sure he was okay for surgery,. After surgery or an. I reported the date of loss and after two weeks,. After they pay the money to you for the damage caused by the. The price of your weight loss surgery will depend on several factors: The type of. These weight loss surgery insurance secrets can save you money, time and even get c. Obamacare weight loss surgery guidelines require insurance companies to provide coverage for all in. Will My Insurance Cover Weight-Loss Surgery. Weight Loss Surgery – Insurance Coverage Criteria. © What will insurane pay for after weight loss surgery 2000-2015.
Insurance and Payment. Understanding your insurance and payment options is often one of the most difficult parts of the weight loss surgery process. Fortunately, Eleanor and our staff are well versed in the insurance process. We’re ready to help you get approved for surgery and discuss your billing and payment options. In recent years, the insurance companies have made it more difficult for prospective bariatric patients to be approved for surgery. Even though this type of surgery is considered “medically necessary” to improve your health and longevity, many insurance providers view it as cosmetic. The key is establishing that your need for surgery is medical. If you’ve discovered that you qualify for surgery , we should be able to work with you to ensure you’re approved for surgery. In the event of an unjustified denial of coverage, we’ll continue working with you to help overturn your insurance provider’s decision. If your health insurance doesn’t cover your weight loss surgery with your surgeon of choice, or fails to approve you for the procedure (or if you don’t have health insurance), NJ Bariatrics has other payment options available. Our billing specialists are happy to discuss our self-pay options and costs with you. The next step is extremely important and often overlooked by bariatric patients. You’ll learn what you should you look for when choosing your bariatric surgeon. Speak with a NJ bariatric surgeon one-on- one to learn more about weight loss surgery. New Jersey Bariatrics has been designated a Bariatric Surgery Center of Excellence by the American Society for Metabolic and Bariatric Surgery, the first such center in New Jersey.
Getting the procedure paid for is another matter, since many insurers and employers are still wary of covering it for children . The surgery costs upwards of $20,000, and it's still being evaluated to determine which adolescents would benefit most from it. If kids are covered by Medicaid or CHIP , the Children's Health Insurance Program, "We know they're covered in Texas," says Trish Walters-Salas , a nurse case manager who handles insurance authorizations for the adolescent bariatric surgery program at Texas Children's Hospital in Houston. "But if it's commercial insurance, it's employer-driven and it's based on what the employer has selected for employees." Forty-seven state Medicaid programs cover bariatric surgery in adults, according to the American Society for Metabolic and Bariatric Surgery . But it's not clear how many of those states pay for the surgery for teens. They also must be mature enough to make profound changes in what their dietary and other changes that the surgery requires. At some companies, bariatric surgery may be specifically excluded for anyone under age 18, says Walters-Salas, the Texas nurse. She called the president of a company once to lay out a case for covering the surgery in a 15-year-old.
Upon review, it is recommended to confirm with your health insurance company to see if weight loss surgeries such as gastric bypass surgery or the LAP-BAND® procedure are covered. It is important that you pledge the cost of the surgery. Although weight loss surgery is endorsed by the National Institute of Health as the only effective treatment for morbid obesity, not all insurance policies cover the cost of weight loss surgery. The Internet can help you gather information about weight loss surgery and insurance coverage. You will also be obtaining a copy of your medical record from your primary care physician to help document your weight over the last 5 years and your prior weight loss attempts, and asking your doctor to write a letter stating the need for weight loss surgery. Know the Codes for Weight Loss Surgery. The CPT Procedure Code for LAP-BAND surgery is: 43770. We recommend that you contact your insurance company to find out if weight loss surgery is a covered benefit, which procedures they will approve, and if you are allowed to select the surgeon you prefer. We recommend you contact the Obesity Law and Advocacy Center (obesitylaw.com). If the answer is “yes,” then ask what CPT procedure codes are covered and if this includes LAP-BAND surgery (CPT 43770).
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.
Many insurance carriers now offer a benefit for weight loss surgery procedures, but the coverage may vary based on your plan. Contact your insurance carriers' member services by calling the number listed on your insurance card. If the member services number is not listed, contact the person at work who manages your insurance policy for that information. The following are questions that you need to ask your insurance carrier before you submit your new patient packet if you plan to pay through insurance: If your insurance carrier covers weight loss surgery, ask them what procedures they will cover and what the criteria is for using your benefit. Your Insurance Carrier Does Not Provide Coverage. In this case, you do not have a benefit and your insurance company will not pay for any procedure. This means that when your employer selected an insurance company and a specific plan with specific benefits to provide health insurance to the employees, they did not choose to pay for, and include, weight loss surgery as a benefit in the overall plan. Unfortunately more and more people are finding it difficult or even impossible to use their health insurance to pay or help pay for weight loss surgery. Your personal bank, your Mortgage Company and now even online Internet financing companies can provide you with a good alternative to using your savings to pay for surgery. To get a quote on the costs involved for your surgery, contact our nurse coordinators at firstname.lastname@example.org or call our office at (504) 349-6860.
I have heard of some insurance companies that will pay for cosmetic surgery after you have lost weight. Best Answer: So let me get this straight, we all pay into health insurance and you want me to pay for your cosmetic surgery because you don't like the way you look now? I suggest to you, that the more insurance pays for anything, the more it costs everyone. Since most health insurance companies will not cover the cost of cosmetic procedures, it can be very challenging to get a tummy tuck paid for by insurance. If there is some type of health problem that can be linked to the need to have a tummy tuck, your health insurance company may be willing to provide some coverage. 4) Have your doctor put you on a diet and exercise regimen that may help correct the problem. If you have difficulty losing weight, the doctor can send the records of your repeated visits as proof that you are having a difficult time losing weight on your own. On the other hand, some health insurance companies may be unwilling to budge on the guidelines that they have for cosmetic procedures. So the faster your metabolism, the faster you burn calories and the easier it is to lose unwanted 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.
For many people, weight loss surgery is covered by their health insurance plan. People without insurance coverage for bariatric surgery must pay for it themselves (self-pay). Your bariatric surgery team is here to help and advocate for you through this process. The cost for bariatric surgery will vary depending on your insurance provider and coverage, your other health considerations, and the providers you choose for various pre-operative testing, counseling, etc. Your bariatric team at Wake Med Physician Practices will work closely with you to estimate your costs, but they cannot guarantee the exact expenses for all required components since Wake Med may not provide all services required before and/or after surgery and every case and every patient is different. Work with your bariatric team to estimate your expenses. This will be helpful for both insurance purposes and for your bariatric surgeon and weight loss team. Understanding Your Insurance Coverage for Weight Loss Surgery. If your bariatric surgeon recommends surgery, start with these steps: He/she may be your best resource for working on your behalf and dealing with your health insurance company. If the insurance company turns down your request for bariatric surgery, you may be able to appeal the decision. Again, work with your bariatric program team for help in figuring out the best approach to appealing a denial of coverage. Alternative Financing Options for Weight Loss Surgery. If you do not have health insurance coverage for bariatric surgery, there are alternative financing options available, such as medical loans.
For most people, the actual process of convincing your insurance company to pay for the procedure is more frightening and more work than the procedure itself. When you call your insurance company to ask about coverage for the procedure, you will likely get an answer of "yes, based on medical necessity". She will assist you as much as possible and guide you though this process, but it is ultimately up to you to prove to your insurance company that you qualify. Here are some of the key steps you should take to obtain insurance coverage for weight loss surgery: CALL YOUR INSURANCE COMPANY: Ask about bariatric surgery (weight loss surgery) and if your policy has coverage for this type of service. All of this documentation is necessary for precertification with your insurance. MEET WITH THE OSC BARIATRIC COORDINATOR AND SURGEON: If it is determined that you are a candidate for surgery and that you have sufficient documentation, we will do the rest. The goal of this letter is to establish the "medical necessity" of weight loss surgery and gain approval for the procedure. A letter from your general physician(s) stating that he or she believes that you are a candidate for bariatric surgery and that you have the diagnosis of morbid obesity.
Redefining healthcare by creating meaningful relationships and experiences with our patients and the community in order to overcome obesity and metabolic disease fostering improved health and a better quality of life. If you are like most people, you are probably extremely frustrated and tired of dealing with excess weight. Our comprehensive program will give you the tools you need to lose the weight you want and to keep it off. When it comes to Texas obesity surgery, it is our goal to not only help you achieve your weight loss goals but to improve your overall health and quality of life.
Once you have made the decision to have surgical weight loss, getting your bariatric procedure approved by your insurance company is the next step. At Mercy Weight Management Center we work with you and help you understand your insurance benefit and also work with you to obtain all of the clinical information and documentation that is required. Here are some requirements that your insurance company will need: Your BMI ( body mass index ) must be 35 or more and you must have at least one of the following; Your insurance determines the number of months needed. If your insurance carrier will not cover weight loss surgery, and you are interested in being a private-pay patient, please call us at 419-251-8760 and we will go over our private pay rates with you.
Will Insurance Cover My Weight Loss Surgery? Depending on the type of major medical insurance policy you have, most insurance companies will pay for bariatric surgery if you meet certain conditions. We have assembled a list of insurance companies and their criteria for determining weight loss surgery coverage. Your bariatric surgery must be considered a medical necessity in order to be covered by insurance. How much of my weight loss surgery will my insurance carrier cover? If you are approved for bariatric surgery, your insurance company will pay between 50 to 100 percent of the hospital and doctor fees. Even if your insurance company will not cover the cost of the actual procedure, they may cover one or more of the other costs related to your gastric bypass surgery. If I lack insurance coverage, can I still consider weight loss surgery? Those tax deductions for weight loss surgery can help you pay for at least part of the cost of your bariatric surgery or help you get reimbursed for your surgery co-payment. It is useful to know that under the Internal Revenue tax code, treatment for weight loss includes behavioral counseling, nutritional counseling, prescriptions, and gastric bypass surgery if those treatments are prescribed to treat or prevent specific diseases caused by excessive body weight. Insurance Companies and Bariatric Surgery Coverage. Following are guidelines supplied by some insurance companies on the criteria used to determine weight loss surgery eligibility:
Does Insurance Pay for Weight Loss Surgery? If weight loss surgery is covered by the insurance policy. If a coinsurance or deductible payment for the weight loss surgery is required by the patient. Types of Weight Loss Surgery. The three most common types of weight loss surgery are the Roux-en-Y Gastric Bypass, the Adjustable Gastric Band, and the Vertical Sleeve Gastrectomy. Gastric bypass surgery will require one to two days stay in the hospital. The port is implanted in the skin during the surgery and is attached to the gastric band. Adjustable gastric band surgery is a reversible procedure, and is considered the least invasive of all of the weight loss surgeries. Patients who are compliant with instructions on diet can usually lose between 30 and 40 percent of excess weight with the gastric band procedure. Weight loss is slower with gastric band surgery and it may take up to five years for complete weight loss. Complications with adjustable gastric band surgery may include band slippage, band erosion into the stomach, and port-related problems, such as bleeding or infection. In vertical sleeve gastrectomy, at least 85 percent of the stomach is removed during surgery. Dieticians specialized in meal planning for bariatric surgery patients will consult with patients after surgery and throughout the weight loss period. Risks Associated with Weight Loss Surgery. Weight loss surgical procedures require major surgery and may be associated with significant risks.
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.
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.
We have the answers to all your pressing questions about weight loss surgery and insurance. In general, the costs of weight loss surgery comprise anesthesia, the hospital facility and the surgeon's fee. And the weight loss surgery is likely not the last surgery you will undergo. Who Foots the Bill for Weight Loss Surgery? Insurance coverage for weight loss surgery varies by state and insurance provider. If you are considering weight loss surgery, the first step is to contact your insurance plan to find out if the procedure is covered and what, if any, caveats may exist. Medicare and Weight Loss Surgery. Medicaid and Weight Loss Surgery. Private Insurance Companies and Weight Loss Surgery. Many private insurance companies will cover weight loss surgery if your primary care doctor informs them that the surgery is medically necessary. Your chosen surgeon can be a partner and a resource in your quest to get your insurance carrier to cover your weight loss surgery. Parting Thoughts on Weight Loss Surgery and Insurance. Remember that it makes good financial sense for your insurer to foot the bill for your weight loss surgery. What's more, the cost of drugs for people with diabetes and high blood pressure plummet following weight loss surgery.
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).
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.
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?
Will Your Insurance Company Pay for Bariatric Surgery? “Will my insurance company pay for weight loss surgery?” If your insurance company will not cover bariatric surgery, our financial coordinator will call you and discuss cash pay options. If you do not have any criteria to meet, call the office at 940-323-3450 to set up an initial surgical consult. To ensure correct documentation, fax your physician’s first office visit note to the insurance coordinator at Dr.
Getting Your Insurance to Pay for Weight Loss Surgery. In fact, most insurance companies require that the patient's weight be stable during this time - with no up-and-down fluctuations - or you may be denied coverage. They want you to demonstrate over the 6 months prior to surgery that you can commit to lifestyle changes you’ll need to make forever after your weight loss surgery. This is to make sure that you understand weight loss surgery and the impact it will have on your lifestyle. When you have completed these steps, the surgeon will send a preauthorization letter to your insurance company. The letter will outline your medical history and health problems related to your weight, and provide documentation that you have completed all requirements for approval. The insurance company will then review your case. During this period, keep accurate notes of all communications between the insurance company and your surgeon.
Overview of Insurance Coverage for Weight Loss Surgery. Many insurance companies will provide coverage for weight loss surgery if it is considered a medical necessity and the patient meets the National Institute of Health (NIH) requirements for bariatric surgery. Some states have passed laws that require insurance companies to cover weight loss surgery if the patient meets the NIH health criteria. Even among insurance companies that provide coverage for the weight loss surgery cost , surgery benefits will usually not be considered unless other weight loss methods have been attempted. NIH Requirements for Weight Loss Surgery. Most insurance companies require a Letter of Medical Necessity for bariatric surgery pre-authorization. Many insurance companies will not consider a request for weight loss surgery unless a patient has previously participated in a medically supervised weight loss program. Appealing Insurance Denials for Bariatric Surgery. If you submit a request for pre-authorization of weight loss surgery and receive a denial from your insurance company, it may be discouraging but it can be appealed. If you and your doctor are not able to convince the insurance company to pay for weight loss surgery, you may want to consult with Lindstrom Obesity Advocacy (www.wlsappeals.com), formerly known as Obesity Law & Advocacy Center, for help and advice. Appealing Insurance Plan Exclusions for Weight Loss Surgery.
> insurance and payment for your weight loss surgery. Insurance and Payment for Your Weight-Loss Surgery. Insurance Considerations for Patients Considering Weight Loss Surgery. Most patients have health insurance benefits, which allow coverage for bariatric surgery. The following is a list of insurance companies and their current policies on weight loss surgery. For patients who do not have insurance that will authorize weight loss surgery we do have a self pay option. However, most insurance companies do authorize weight loss surgery and we have a very high success rate at authorizations. We are able to get most insurance companies to authorize and pay for most of the hospital charges and some of the surgeon fees. Our preference is for you to use your insurance to avoid the significant hospital and other related costs. Please be aware that most insurance companies do authorize the Gastric Bypass , fewer authorize the Duodenal Switch , and Lap Band ®, and the Vertical Gastrectomy . In most states, review boards can - and often do - overturn an insurance company's denial for surgery.
Medicare for Weight Loss Surgery. In most cases, Medicare will cover a significant portion of the surgical procedure as long as the patient qualifies for bariatric surgery under their guidelines. Medicare has approved coverage for several weight loss surgery procedures including Gastric Banding (Lap-Band®), Gastric Sleeve and Gastric Bypass . This makes it all the more important for the patient, with the help of their primary physician and bariatric surgeon , to submit a complete and accurate claim application for coverage. Medicare is an option in paying for bariatric surgery that should be fully explored, however every patient relying on Medicare coverage should educate themself about the process. In order for our office to verify your weight loss surgery benefits and provide a cost estimate, please supply the following optional information:
Home > Insurance and Financing. Insurance and Financing. Your coverage and the requirements you must meet depend on what your employer (or you) purchased in the policy. For example, if you and your neighbor both have Humana insurance, one of you may have coverage for Lap-Band surgery and one of you may not. Southwest Bariatric Surgeons wants you to know your coverage availability, requirements, and financial responsibilities before you have your first appointment so you can avoid surprises along the way to surgery. When you attend one of our seminars , you’ll be provided with a questionnaire that includes some basic questions about your health and requests your insurance information. We strongly recommend that you read your insurance booklet and/or contact your insurance company and visit their Web site to learn about your coverage and any coverage requirements. Southwest Bariatric Surgeons hopes that your surgery will be covered by your health insurance, but not all policies provide coverage. In the event we discover that your policy does not have coverage, we will contact you to discuss the cost of surgery and provide you with contact information for companies that provide financing.
One of the main concerns for many people when considering weight loss surgery is cost. If you have health insurance, the first thing to do is to confirm whether you have coverage for bariatric surgery or not. If your insurance provider indicates that you have coverage “if it is deemed medically necessary,” this means that you have benefits for weight loss surgery. The insurance experts at our office will verify the specific benefits you have and will go over all of the specifics about your insurance coverage and the requirements for approval for surgery when you meet with us at your first consultation with your surgeon. If your insurance provider indicates that you have “exclusion” on your policy, this means that your employer has opted not to cover this benefit for employees. Q: How much does the surgery cost if my insurance will not pay for it? Cost variables exist with each procedure and we will give you specific pricing at your initial visit or at the informational seminar. If you are paying for the surgery outside of insurance, the costs of the procedure starts as low as $9999 for the lap band and $12,999 for the lap sleeve if the procedures can be done at the outpatient surgery center. It also includes your first 6-months of follow-up appointments for the sleeve gastrectomy. We do not include the the first 6-months appointments for the gastric band. These costs will include the surgeon fee, the hospital fee following surgery, all operating room time, nursing staff, supplies, instruments, medications, Anesthesia fee, and your anesthesia team. You can apply for a loan through either patient financing institution to help you afford the cost of surgery.
Don't have insurance coverage to pay for your surgery? Or maybe you don't want to go through the ridiculous insurance requirements which may delay your surgery for the better part of the year? Perhaps your BMI is too low for insurance to pay for weight-loss surgery. Your surgery will be done by the Board Certified, Center of Excellence surgeons of Alabama Weight Loss Surgery. Your outpatient surgery will be performed at Outpatient Services East Ambulatory Surgery Center, located on the campus of St. But before you get to the OR, you will consult with your surgeon who will evaluate your suitability for the surgery. At this time, a plan will be developed to ensure that you are in the best condition for the procedure and our staff will then assist you on every step of your journey to the OR. Therefore you will meet with the bariatric nutritionist prior to surgery. Six weeks after your surgery you will have a follow-up meeting with the nutritionist, and this too, is included in the package price. Ask our office or your surgeon about the specifics of this coverage. While your surgery will be a one day affair, we will be your weight-loss partner for years to come.
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.
For many people, weight loss surgery is affordable because it is covered by their health insurance plan. Some patients pay for their own surgery and consider it a critical investment in their health. Many people find dealing with health insurance companies to be intimidating and are not sure how to even get started. Your best resource for how to deal with your health insurance company may be your weight loss program. New Start has weight loss coordinators who work on your behalf with your health insurance company. Write down your weight loss history. If possible, pull together receipts for gym memberships and weight loss programs. This documentation can be useful for your weight loss surgery program and health insurance company. If the insurance company turns down your request for lap band or other weight loss surgery, you may be able to appeal the decision. Work with Your Weight Loss Surgery Program. Our New Start program is designed to ensure that when the day of your surgery arrives, you'll be ready and in the best possible condition for a fast, healthy recovery. Choose a location to start finding out if weight loss surgery is right for you.
We can’t tell you whether your insurance covers surgery, but on this page we will explain how to work with your insurance provider to see if you have bariatric surgery insurance coverage. Step 1: Find out if you have coverage for bariatric surgery. May I have a copy of the Medical Policy statement for bariatric surgery insurance coverage? You have the right to access this information under most insurance agreements. Step 2: If surgery is covered, work with your bariatric practice to gather all the required documentation for pre-approval. Typically, your surgeon's office will submit the required information to your insurance provider to gain pre-approval. Check in with your bariatric practice to ensure that they submitted your information, or follow up with your insurance company in about a week if you submitted materials yourself. Ask your insurance provider for specific reasons. Call the member services phone number listed on your insurance card. You will also need to know your group number, which is also on the insurance card. You may want to consider working with your bariatric practice to discuss the next steps in appealing for coverage. Find the number for your state below. Lastly, you can try calling your state insurance department to register a complaint.
We have a team of insurance specialists to help you through the insurance maze. Insurance coverage is one of the biggest concerns among bariatric patients. The fact that your surgeon feels surgery is medically necessary and that you meet the surgical eligibility criteria does not automatically mean that your insurance company will pay for surgery. The surgical coverage benefit is primarily determined by the policy holder’s employer, not the insurance company. Even if you are in the initial stage of considering weight loss surgery, it may benefit you to know what to expect from your insurance company.
Qualifying for Bariatric Surgery with Your Insurance Company. Before your consultation, you should contact your insurance company to make sure your plan covers weight loss surgery. Tell the customer service representative you are interested in Gastric Bypass/LAP-BAND® surgery and ask if the service is covered on your plan. If they say the service is not covered or is excluded, this means your employer or whoever you get your insurance through, did not pay for this benefit. Do I have to have certain co-morbid conditions (medical conditions related to your weight?) If so, what are the conditions? Do I have to complete a physician supervised diet, and for how long? Can you provide me with a checklist (the requirements for surgery)? Please contact our insurance department if you have any questions: 515-241-2250. We strongly encourage patients to contact their insurance companies to see what is required for their pre-approval. If this is a requirement of your insurance plan we can not submit your pre-approval until this diet is completed. Contact your physician and ask if this diet was documented in your medical records. Don't forget to contact your insurance company because their requirements may be different than what you have already completed. Again, check with your insurance company to see what they require for insurance approval.
That’s especially the case in the Deep South where obesity rates are some of 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, whether prescription drugs or bariatric surgery. That long-standing culture – and 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. But the procedure is pricey — an average of $42,000 — and many small employers, including those in Mississippi, don’t cover it. “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 Morton. 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 have to be covered in plans sold on the exchanges. Some of these states — Alabama, Louisiana, Arkansas, Texas and Mississippi — have the highest obesity rates in the nation, according to the Centers for Disease Control. “If they don’t have insurance, they’re not going to get the therapy,” Morton says. Therese Hanna, Executive Director of the Center for Mississippi Health Policy , isn’t surprised that obesity treatments are excluded in plans sold on the insurance exchange in her state. Hannah says Mississippians who buy insurance on the exchange will likely be the cashiers, cooks, cleaners and construction workers that make up much of the state’s uninsured. “And that’s been most of the discussion in our state is how do we provide the kind of care for things like high blood pressure, diabetes and heart disease. If possible, please include the original author(s) and “Kaiser Health News” in the byline. So everything a patient eats in a gastric bypass is not going to be absorbed.” After surgery, many of the complications of obesity, like sleep apnea and high blood pressure, are reversed. Why is it that we don’t see obesity coverage routinely?” Therese Hanna, Executive Director of the Center for Mississippi Health Policy , isn’t surprised that obesity treatments are excluded in plans sold on the insurance exchange in her state.
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.
Our goal for all of our patients is to improve access to bariatric surgery and decrease the financial strain associated with major surgery. If you will contact our office we can let you know if your insurance contract is eligible for this and get you the paperwork you would need to start the process of determining if you qualify. Patients considering the self-pay option can come in for a free consultation. The self pay price for gastric sleeve can also frequently be reduced to $11,750 if you qualify from a health history standpoint for surgery in a surgery center. If you're Insurance has an exclusion for bariatric surgery we frequently can get partial coverage for weight-loss surgery. In this circumstance your insurance would be billed for the indicated procedure that was covered and there would be an additional amount paid for the gastric sleeve or gastric bypass. We can assist in the workup of the hiatal hernia and getting you qualified for the hiatal hernia procedure. Example: Insurance billed for hiatal hernia with your usual deductable. This price can also be reduced to $4500 if you qualify for a surgery center procedure. Four instance, while your employer may provide Blue Cross insurance for the employees, the employer may have chosen to exclude bariatrics surgery from their specific plan as a cost saving measure. Hodge's office can assist you in getting through this requirement and can see you for these visits to satisfy this requirement.