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.
Insurance companies often require extensive documentation regarding your weight history and your attempts at weight loss. Before you contact your insurance provider, you should collect as many documents as you can, including: It is important that you gather this official documentation and it is in your best interest for it to be as complete as possible. Insurance companies will require official documentation before they are willing to subsidize or cover the costs of bariatric surgery. If you are missing documentation, you may be able to obtain copies from your physician or the commercial weight loss programs you have participated in. Upon receiving the required documentation, our insurance specialist at My Bariatric Solutions will review the material to ensure that it meets the guidelines outlined by the insurance company and send a letter of recommendation to your provider, recommending bariatric surgery for your continued health. At My Bariatric Solutions, we will work diligently for approval from your insurance provider. If your insurance provider denies the request, we can assist you in an attempt to appeal the decision. We offer an array of financing options and can assist you quickly and confidentially. Submit your inquiry from any device, no matter where you are. The risk-free process allows you to review all terms before proceeding and requires no collateral with no prepayment penalties. The instant pre-approval process will not affect your credit on the standard program.
And like many critically overweight Americans, Harrison cannot afford to have weight loss surgery because her health insurance doesn't cover it. As a result, she and her family are trying to raise $15,000 to pay for the surgery that she thinks will save her life. Patients underwent weight loss surgery — roughly the same number as in 2004. That's only about 1% of the estimated 18 million adults who qualify nationwide for the surgery, according to the American Society for Metabolic and Bariatric Surgery. And early signs indicate many of the same challenges seen in the private market have carried over to the new, state-run insurance exchanges that are part of the health care overhaul: Only 24 states require insurers to cover weight loss surgery for patients. Insurers have said for years that bariatric surgery should only be used as a last resort, hence the many preliminary requirements and evaluations. But the insurance hurdles are pushing up against new medical guidelines urging doctors to more aggressively address obesity, including referring patients for surgery. Guidelines issued in November by the American Heart Association, the American College of Cardiology and the Obesity Society call on doctors to calculate a patient's body mass index — an estimate of body fat based on weight and height — each year, and recommend surgery for those who face the most serious health problems. The latest long-term studies show that the typical patient loses about 30% of their excess weight with the bypass procedure and 17% with the band after three years. The benefit is often hardest to find in states that have the highest levels of obesity, such as Mississippi and Arkansas, where less than 25% of employers cover weight loss surgery. Surgeons say many patients are unable to keep up with the appointments and never qualify for surgery — a fact which they say helps insurers control costs. America's Health Insurance Plans , the industry trade group, says companies are simply following federal guidelines that recommend surgery for "carefully selected patients" who have failed other methods. But the National Institutes of Health guidelines insurers point to were issued in 1998, when weight loss surgery was still an emerging field with serious risks. At the time, about 1 in 100 patients died in surgery. Additionally, about 20% of patients who get the gastric band regain nearly all of their weight within three years — a fact that has led to a decline in popularity for that procedure.
If you are thinking about bariatric surgery and have doubts about whether it is right for you, you’re not alone. For many people, bariatric surgery is affordable because it is covered by their health insurance plan. People who do not have insurance coverage for bariatric surgery must pay for it on their own. Your best resource for how to deal with your health insurance company may be your bariatric program. Many bariatric programs have patient advocates who work on your behalf with your health insurance company. If the insurance company turns down your request for bariatric surgery, you may be able to appeal the decision. Work with Your Bariatric Program. It is critical that you work with your bariatric program to determine the correct approach to appealing a denial. This documentation can be useful for your bariatric program and health insurance company. If this is the case, there are steps you can take if your employer has decided not to include bariatric surgery as a covered benefit. Share your story and how you believe bariatric surgery will benefit not only you, but your organization as well. Take the time to educate your coworkers about the surgery and its importance. If you do not have health insurance and would like to have the surgery, you may want to explore alternative financing options.
The Nicholson Clinic for Weight Loss Surgery’s founder talks about the honor. The Nicholson Clinic for Weight Loss Surgery - One of the Pre-Eminent Weight Loss Surgery Centers in the Country. Welcome to the Nicholson Clinic for Weight Loss Surgery - led by Dr. Weight loss surgery is a monumental decision that patients often arrive at after many years of suffering with obesity. The physical and emotional ramifications of the weight itself, as well as the many conditions that often ride the coattails of obesity, can dramatically cut lives short. Obesity is an epidemic that can be partially addressed by expert, compassionate weight loss surgery, comprehensive after-care, and a patient's commitment to change his or her lifestyle through diet and exercise. We understand that bariatric surgery affects patients physically and emotionally, and we provide support every step of the way - from choosing the best surgery to addressing your personal weight loss challenges and goals and preparing for surgery, to recovery, after-care, and long-term support. Our patients know that they have a partner in their weight loss surgery with the Nicholson Clinic. Nicholson being named one of D Magazine’s “Top Bariatric” doctors for nine years in a row, the Nicholson Clinic is accredited and dedicated to quality, operating at Centers of Excellence as recognized by the American Society for Metabolic and Bariatric Surgery (ASMBS) and facilities awarded the Blue Distinction designation by Blue Cross Blue Shield. The Nicholson Clinic is affiliated with.
In February I will be eligable for health insurance through my job, but is there a way I can find out the difference between individual. In February I will be eligable for health insurance through my job, but is there a way I can find out the difference between individual healthplans and know if it covers bariatric surgery? And, as others have said, you may not qualify for an individually purchased health plan if your BMI and co-morbidities are significant enough to need bariatric surgery. Once you're eligible for your employer's plan, then you can inquire whether or not bariatric surgery is covered. (If your employer offers more than one plan option, you should be able to request the details of each policy for use when deciding between the plans.) Whether or not bariatric surgery is covered isn't a blanket decision by the insurance company for all groups. You can't just use the name XYZ insurance company to determine whether they cover bariatric surgery - you have to know what specific policy you'll be enrolling under. BTW - you should be advised that there is a lot of documentation required to get insurance approval for bariatric surgery. You can only upload files of type PNG, JPG, or JPEG. You can only upload files of type 3 GP, 3 GPP, MP 4, MOV, AVI, MPG, MPEG, or RM. 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.
Insurance and Financing Services for Weight Loss Surgery. Whether you’re looking to apply for services with your current medical insurance provider, or acquire financing to fund a surgical weight loss procedure, Texas Bariatric Specialists is with you every step of the way. This full service ensures you are receiving the full benefits you are entitled to, alleviates the hassle for your, and provides you with peace of mind. Just provide your insurance information and they will take it from there. From there you would key in your insurance information and wait for a phone call to schedule your initial appointment. You will then be assigned an advocate that will be with you every step of the process talking with you and your insurance company to get your approval as quickly as possible. Your weight loss history with other programs.
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.
In order to qualify for bariatric surgery you must meet all of the requirements below. You must enroll in United Healthcare’s Bariatric Resource Service and the bariatric surgery must be performed at a United Healthcare Center of Excellence facility. After bariatric surgery has been performed under this benefit, you must provide documentation which shows you have participated in a medically supervised lifestyle management program for maintaining weight loss and healthy lifestyle goals for twelve (12) consecutive months after the date of the surgery. The coverage rules for bariatric surgery are different than any other Health Select benefits: You are responsible for 20% coinsurance of the allowed amount of the surgery and all related services. Health Select will not pay more than $13,000 for bariatric surgery and related services, including prescription drugs. You will have to obtain a referral from your Primary Care Physician (PCP) to the specialist who will perform your bariatric surgery at the Center of Excellence previously identified. The specialist who will perform the surgery will discuss other medical requirements that might apply for bariatric surgery. If you or your physician has questions regarding the Health Select bariatric benefits, call 866‐336‐9371. You must provide a predetermination form and all related medical documentation showing that you satisfy the requirements for bariatric surgery. After United Healthcare has reviewed the predetermination form, you will receive a letter from United Healthcare approving or denying coverage for bariatric surgery. If you are approved for bariatric surgery, verify that your physician who will be performing the surgery preauthorizes your inpatient stay at the Center of Excellence. For at least twelve (12) consecutive months following the date of your bariatric surgery, you must participate in a medically supervised lifestyle management program for maintaining weight loss and a healthy lifestyle. The bariatric surgery period is one (1) month before and twelve (12) months following the date of the surgery. If you have questions about Health Select bariatric surgery coverage or benefits, contact the toll free number on the back of your ID card or call 866‐336‐9371.
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.
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.
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.
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.
Medicaid covers weight loss surgery if you meet the specified criteria listed here. Does Medicaid Require Surgery at a Center for Excellence? Does Medicare & Medicaid Cover Weight Loss Surgery? Medicare & Medicaid Overview of Medicare. Of surgeons that will accept Medicaid and or Medicare for Bariatric surgery. Read posted questions and answers concerning bariatric surgery and medicaid at Caring.com. Medicaid Coverage & Bariatric Surgeons your bariatric surgery insurance coverage (they'll usually do this regardless. Medicaid covers bariatric surgery sneak peak! Medicaid Guidelines for Coverage of Bariatric Surgery Medicaid bariatric surgery to determine eligibility for bariatric surgery must cover all of the following:. Humana, Tricare, Medicare, Medicaid. For patients without health insurance or bariatric coverage, we offer competitive and affordable .
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.
Most insurance companies require a letter outlining a patient’s weight loss history and the medical necessity for the surgery before they will even consider financing the procedure. The following pdf is an outline of the important points and steps to take in order to get the coverage you need for your weight loss surgery. The whole process can be very discouraging and uncomfortable and may cause to delay your surgery. First and most importantly, they makes it easier for you to get the surgery you want when you need it. Second, financing makes surgery accessible to a wider range of patients by providing a payment solution that fits comfortably into your monthly budgets and lifestyles. Plus you can reserve your consumer credit cards for unplanned and household expenses. So now that financing is a viable alternative if you are denied coverage by your insurance company or you don’t count with one. You can learn more about Lone Star Surgical financing options by visiting the following link or by calling or emailing Martha Romero, our Insurance Analyst, at [email protected] .
Arizona, Blue Cross and Blue Shield. Arkansas Blue Cross and Blue Shield. Delaware, Blue Cross and Blue Shield. Florida, Blue Cross and Blue Shield. Georgia, Blue Cross and Blue Shield. Illinois, Blue Cross and Blue Shield. Kansas, Blue Cross and Blue Shield. Louisiana, Blue Cross and Blue Shield. Michigan, Blue Cross and Blue Shield. Minnesota, Blue Cross and Blue Shield.
Blue cross blue shield texas insurances that cover bariatric surgery. Blue Cross Blue Shield of Texas' Criteria for Insurance Coverage. Minimum requirements for Blue Cross Blue Shield Texas obesity surgery approval (if your plan covers it); Bariatric surgery procedures covered by BCBS Texas . Blue Cross Blue Shield of Texas, the state's largest health insurer, requires. Blue Distinction® Centers for Bariatric Surgery. Does your insurance plan cover the cost of gastric sleeve surgery. Blue Cross- Blue Shield programs and United Healthcare all cover gastric sleeve surgery . Blue Shield of Tennessee: Blue Cross Blue Shield of Texas: Blue Shield of . Blue Cross and Blue Shield of Texas: Texas A&M University. BLUE CROSS BLUE SHIELD TEXAS. Texas Blue Cross Blue Shield .
Working in a hospital we have noticed in the last year that a lot more insurance company's are paying for the surgery. Also most of the time if your primary insurance want cover it the 2ndary want touch it either, What I would do is I would find out how much the surgery would cost an find out from the hospital what is there contractual is with the insurance company. You have to think of all the charges the ans, lab, drug, doctor, surgeon. Like say for example diabetes if on insulin you have to pay for the insulin your needles your monitor an strips. Then with diabetes you have other problems. You might can get them to change there mind on there policy if it saves them money in the long run. Insurance companies don't usually cover voluntary procedures - and bariatric surgery is considered voluntary, because there are other, safer methods you can use to achieve the same results. That's because, for cosmetic, bariatric, and infertility stuff, the ONLY people who want to buy it, want to use it. You can only upload files of type PNG, JPG, or JPEG. You can only upload files of type 3 GP, 3 GPP, MP 4, MOV, AVI, MPG, MPEG, or RM. You can only upload photos smaller than 5 MB. You can only upload videos smaller than 600 MB. You can only upload a photo (png, jpg, jpeg) or a video (3gp, 3gpp, mp4, mov, avi, mpg, mpeg, rm). You can only upload a photo or a video.
Aetna Insurance Covers Houston Weight Loss Surgery - Gastric Sleeve. People who suffer from morbid obesity (being overweight) can consider a new primary weight loss surgery known as the Laparoscopic Sleeve Gastrectomy (LSG), or the Gastric Sleeve Surgery in Houston, Texas. People who suffer from morbid obesity can consider a new primary weight loss surgery known as the Laparoscopic Sleeve Gastrectomy (LSG), or the Gastric Sleeve Surgery. Gastric sleeve surgery is a minimally-invasive laparoscopic procedure done by placing a scope through small incisions made in the abdomen. Laparoscopic Sleeve Gastrectomy is a relatively new procedure devised for people who are severely obese and who may be suffering from serious medical problems because of the obesity (e.g. As a result of gastric sleeve the patient is literally less hungry, and post-operative dietary recommendations are easier to follow. Aetna Insurance requires that patients participate in an organized multi-disciplinary surgical preparatory regimen within 6 months prior to the weight-loss surgery. There are several advantages gastric sleeve has over other weight-loss surgeries for Houston patients. The intestine is not rearranged, as would be the case with Gastric Bypass surgery. Houston Surgical Specialists report that the gastric sleeve operation has dramatically lower long-term complication and re-operation rates than Gastric Bypass. Note that you must have engaged in a documented physician-supervised nutrition and exercise program during the two-year period prior to the surgery to receive Aetna coverage. Houston Surgical Specialists is a multi-physician practice that specializes in helping those who suffer from morbid obesity located in the great state of Texas. They are recognized by the pre-eminent society of weight loss surgeons in the United States, and are one of the premier practices for obesity care in the Houston, Texas area.
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 .
Most major insurance companies cover the Lap-Band® procedure*. Lap Band Solutions will conduct a free nsurance assessment to find out your benefits and requirements to have the LAP-BAND surgery. Lap Band Solutions will give you all the information of the requirements, coverage, and out of pocket expense that is needed by your insurance at the time of your initial consultation. Understand the Insurance Process and Exclusions. *Although most insurance pays or covers the lap band procedure, your employer may have excluded Morbid Obesity from your plan. Please note: The CODE for LAP-BAND® for insurance purposes is CPT 43770, diagnosis code 278.01: morbid obesity.
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?
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.
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.
The documentation also must contain a description of why the bariatric surgery is medically necessary. The prior authorization request must include documentation to show that the patient has demonstrated his/her compliance with medical treatment. The patient also must have demonstrated at least 6 months of compliance with a physician directed, non-surgical weight-loss program that occurred with 12 months of the request date. That the patient is psychologically mature and can cope with the post-surgical changes. That the patient and the parent/guardian (as applicable) understand and will follow the required changes in eating habits. How the patient will accept post-operative surgical, nutritional, and psychological services.
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 [email protected] or call our office at (504) 349-6860.
AIBL offers some of the least expensive prices to make bariatric surgery cost in Texas affordable because we are sensitive to our self-pay patient needs and concerns. Once you have made a decision to become healthy, achieve permanent weight loss and live life to your fullest, the most common barrier for surgical weight loss procedures including the lap band or the gastric sleeve is the cost of bariatric surgery. Ganta performs all of the Bariatric procedures, he is able to make an unbiased recommendation to you on which option is best for you. Once you’ve decided on an appropriate procedure during the same appointment our office will provide you with pricing information that includes hospital and anesthesia fees along with our office fees as a package price. Our package price cost of a gastric sleeve and other bariatric procedures include: The post-operative support program, including diet and exercise counselling are included in the initial cost of bariatric surgery. You will be provided with a detailed policy and charge list outlining all of the estimated charges at the time of your initial consultation. Financing bariatric surgery and payment plans. Payment plans and financing options for the surgery are available through AIBL office. Approval and the credit limit are based on your credit history. You may finance the entire cost of surgery including anesthesia and hospital charges. You may finance your out of pocket portion of the bariatric surgery cost even when your insurance covers the procedure. AIBL will work with you through the whole process to make sure that your experience is pleasant and well informed as you go through financing options for your Texas bariatric surgery cost.