Insurance and Financial Information
Insurance coverage is an important consideration for bariatric surgery patients. We work with most commercial insurances, however insurance plans vary in the benefits they provide. Prior to your initial visit, please contact your insurance company to find out if surgery for morbid obesity is a covered benefit under your policy. You are responsible to verify your specific policy, benefits, and bariatric surgical criteria (e.g. medically supervised diet requirements, pre-operative weight loss requirements, history of obesity, history of diets attempted, etc). We will arrange out-of-network benefits if available. You are responsible for deductibles and co-pays as outlined in your policy. Financing for out-of-network co-pays and deductibles are available in the office.
Obtaining authorization from your insurance company for obesity surgery is necessary prior to surgery. Your cooperation in providing the right documentation will help our insurance specialist in obtaining approval. We need as much documentation as you can provide regarding your attempts at dieting and, particularly, any medically supervised diet plans. Also provide documentation of any associated medical problems such as high blood pressure, diabetes, sleep apnea, or orthopedic problems. Letters from specialists or personal physicians in support of the surgery are particularly beneficial.
Obtaining approval can take several weeks to complete. Your insurance company will request copies of the consultations set up by our program in order to determine if you meet their specific criteria for weight loss surgery. On occasion insurance companies will deny an initial request despite our policy of utilizing National Institutes of Health criteria in patient selection. In the event you receive a denial, you need to go through the proper channels and appeal. The appeal must come from the policyholder and many companies will back down and approve coverage when faced with a determined patient. We can recommend legal assistance if you receive an unreasonable denial.
For those patients who want to pay cash for the procedure, a discounted package rate is available that includes surgeon and assistant fees, and hospital and anesthesia charges. All fees must be paid in advance. We offer financing through our office for the surgeon fees.
Financial and insurance questions can be directed to our billing department at 1-877-269-0355. Please do not hesitate to call us.