Insurance and Financial Information

Obtaining authorization from your insurance company for obesity surgery is necessary prior to surgery. Your cooperation in providing the following documentation will help in obtaining approval.

We need as much documentation as you can provide regarding your attempts at dieting and, particularly, any medically supervised diet plans, plus your current weight and height. Also provide documentation of any associated medical problems such as hypertension, diabetes, sleep apnea, or orthopedic problems. Letters from specialists or personal physicians in support of the surgery are particularly beneficial.

We provide a questionnaire that will assist you in organizing this information.

It is usually necessary to see you in consultation before your insurance company will consider a request for surgery.

Obtaining approval can take several weeks to complete. Your insurance company will request copies of your 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 NIH national 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.

Insurance Plans

We accept most private insurance plans and will arrange out-of-network benefits if available. You are responsible for deductibles and co-pay amounts as outlined in your policy. Financing for out-of-network co-pays and deductibles are available in the office.

Once information regarding eligibility for surgery is received, pre-certification is requested from your insurance company. You are also responsible for contacting your insurance company to find out what your coverage includes and what the requirements are for bariatric surgery.

Cash

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 Katie Baker (315-624-4740). Do not hesitate to call.