How To Pay For Weight Loss Surgery: Financing
If you do not have coverage, you can work with a third-party financing company to fund your expenses. To obtain this, the first step is to speak to our doctors about your needs. Well provide you with an exam and discuss the best type of weight loss surgery for your needs, risks, and goals youll need to meet before going forward. Then, we can work with you to obtain financing for the procedure.
Olde Del Mar Surgical has an established relationship with Prosper Healthcare Lending. Their benefits include:
- Immediate decisions for loans under $35,000
- Longer terms for lower monthly payments
- No collateral required
- The fast and easy loan inquiry process
- 100% confidential
With this option, you may consider paying for your care in advance. The costs for hospital stays and other medical expenses can seem overwhelming initially. Still, many hospitals and medical facilities will offer substantial discounts to patients who pay for their care in advance. This reduces a great deal of risk for the hospital, and they can afford to lower their prices.
Bariatric Surgery Who Needs It
Typically, when all options like exercise, diet control, etc. fail, bariatric surgery is the only option to lose weight. The World Health Organization measures obesity in terms of the body-mass index or BMI. Any person with a BMI of 30 or more is considered obese.
Obesity can be a serious health problem interfering with basic functions like breathing, sitting, sleeping, etc. If the BMI goes beyond 40 or if a person with a BMI of 35 has existing conditions like diabetes, high blood pressure, etc., then the person is said to be suffering from morbid obesity.Bariatric surgery is usually recommended to patients with morbid obesity or those weighing more than 100kg than their normal body weight .
While the cost of the surgery can vary based on the type of surgery, hospital, surgeons fees, etc., the average cost of bariatric surgery in India is between 2.5 lakhs and 5 lakhs.
What Can I Do To Ensure Approval
Before your consultation, youll be given a patient health history questionnaire. Its important to fill this out truthfully and completely because it will be translated into your medical record, which will be reviewed by the insurance company.
If you have any documentation of your previous attempts at weight loss whether by diet, exercise or medical supervision, bring a copy to be reviewed and scanned into your chart.
If youve had a previous weight loss procedure, you should obtain copies of your operative report as well as pre- and post-op visits to demonstrate your committed follow-up and compliance with any recommendations that were made by your former provider.
The single most important thing that every patient should do to ensure the likelihood of approval by their insurance company is to remain in full compliance with the requirements set forth in the medical policy . Medically supervised diets often must occur in consecutive months and should be spaced out by approximately 30 days. Failure to keep scheduled appointments in consecutive calendar months will often result in denial and may delay surgery or cause you to have to re-start the prescribed program from the beginning.
The MultiCare Center for Weight Loss & Wellness supports you before, during and after the weight loss journey.
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So How Does Bariatric Surgery Insurance Work
Few years back, bariatric surgery was a standard exclusion across the industry. However, with the changing needs of the world and the technical advancements, bariatric surgery is considered by many insurance companies now. If you are hospitalized for a Bariatric Surgery which is medically necessary, on the advice of a Medical Practitioner, we cover the related medical expenses. However, it is to be kept in mind that Bariatric Surgery Insurance benefit can be availed only when it is medically necessary and not for cosmetic purposes.
Tools Provided To Complete Your Insurance Requirements
- A unique concierge service to help you complete your surgeon visit, dietary, and psych evaluations all on the same day and in the same office as your seminar.
- An insurance advocate that will help you understand your personal requirements and help you with all of your questions and concerns throughout your weight loss journey.
- Some of our locations are open on Saturdays to work around your schedule.
- A login for our patient portal to track your progress and see what else youre required to complete before surgery.
- Nine clinic locations across South Texas for appointments and fully stocked with bariatric protein and vitamins.
- Support Group meetings once a month and an online Support Group if you prefer to stay home. Pre-operative patients are urged to check out one of our support groups to ask questions and learn about life post-operative from former weight loss surgery patients.
- If you have a smartphone, we have a free app available in the iTunes and Google Play store. Click here for more information about our Smartphone App here.
Even with insurance hoops, at Texas Bariatric Specialists, we strive to make your entire experience effortless. TBS will be with you every step of the way so you will never feel alone or lost in your journey.
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Does Blue Cross Blue Shield Florida Blue Cover Bariatric Surgery
Blue Cross Blue Shield of Florida now known as Florida Blue is our states largest health insurance provider with over 50% of Floridians covered under their plans. BCBS offers members a range of plans including Individual & Family, Medicare and Group Health. The Memorial Advanced Surgery providers are in-network for most of these plans. Our team is happy to discuss your benefits and coverage for weight loss surgery and help guide you through what is required for coverage.
Note: In network providers are able to offer a lower out of pocket expense to patients than providers that are out of network by the plan.
Cover For Weight Loss Surgery Vs Weight Management
Cover for weight loss surgery
You’ll only find health insurance for weight loss surgery with a gold-tier hospital policy. If you’re not already on one, you’ll want to get on one soon because there will be a waiting period, usually around 12 months.
Cover for weight management
Many extras policies cover weight management programs like fitness classes, money off gym memberships and nutritional consulting programs such as WW and Jenny Craig. This can give you a chance to learn new wellness habits pre-surgery or, in some cases, avoid having surgery altogether. Waiting periods are a lot shorter usually around 2 months.
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How To Go For An Insurance Appeal To Pay For Bariatric Surgery
To go for an appeal, start with an oral complaint to your insurance provider. You may need to get additional documents to make your appeal successful. Most insurance providers only accept appeals within a limited number of days after the denial. This is usually up to 60 days.
If you have decided to appeal the decision of the insurance company, start by checking if your plan provides bariatric surgery coverage or not. If you have your companys health insurance, contacting the HR department for your insurance details. Next, contact your surgeon. Many clinics now have expert denial staff that helps with the appeals process. Get records of your familys medical history that will make your case stronger. You may need additional documents from your surgeon about your medical health as well.
With your appeal application, attach a letter explaining why you must get the surgery. Mention the facts emotional rants will not help your case at all. You may want to include a letter from your surgeon as well, that corroborates your need for surgery. Other documents will include a copy of the denial for insurance and additional medical documents. Request for an explanation of the denial. If you are still denied, check if you can appeal again or contact your states Department of Insurance. You may be patched up with people in the department who work specifically on denials.
Insurance Coverage For Weight Loss Surgery
Insurance coverage for obesity surgery varies according to the insurance carrier. Those that cover bariatric, or weight loss, surgery often limit their coverage to certain types of surgery.
Insurance companies that cover bariatric surgery have varying requirements. Some may require medical records documenting that you have medical problems caused by your weight or records of your participation in medically supervised weight loss programs. In fact, many insurers require at least six months participation in a supervised weight loss program within two years of your proposed surgery date.
Our office participates with many insurance plans. But whether we participate or not, our surgical scheduler can work with you and your insurance company to obtain authorization for your surgery. Each insurance plan is unique, and getting authorization for surgery is often a long, labor-intensive process.
Prior to visiting our office, please:
- Write down the name of the person you speak with, including first name, last name, and direct phone number.
Your insurance carrier may request the name of the surgery and the CPT/ICD-9 codes. Insurance companies use the following codes to identify the type of procedure or surgery:
- Lap Gastric Banding: 43770
- Lap Gastric Sleeve: 43775
- Diagnosis Code for Morbid Obesity: E66.01
When you have a surgery date, it may take another two weeks to two months to obtain approval from your insurance carrier.
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Does Anthem Blue Cross Georgia Cover Bariatric Surgery
One of the first questions that our Georgia patients ask is whether their insurance will cover bariatric surgery and if so, what will their out-of-pocket expense be?
Anthem Blue Cross Georgia is the largest health insurer in the state with over 1,000,000 policies and over 30% market share. As a result, Blue Cross is often at the forefront of insurance company policy changes as they relate to coverage of bariatric surgery and other procedures.
The most important thing to understand about any health insurance policy is that beyond the list of covered procedures, there are also specific exclusions. Bariatric surgery is a common exclusion and a read through your policy documents and calling Anthem Blue Cross Georgia can give you clarity on your specific policy. We can also assist you in verifying your benefits, but it is important that you speak to your insurance to clarify any questions you may have.
How Does Obesity Affect Health Insurance
About 19% of children and 42% of adults are obese, according to the Centers for Disease Control and Prevention. Obesity has been tied to many health conditions, including:
- Some types of cancer
All told, obesity costs the health system $147 billion a year, the CDC says.
A 2018 study published in the Journal of Obesity & Weight Loss found that the average percentage of expenditures for health care related to obesity during the years 2010 through 2015 was:
- 9.21% for commercial insurance
- 8.48% for Medicaid
- 4.74% for patient out-of-pocket spending
Given all these costs, can health insurance companies charge you higher premiums if youre obese?
Health insurance companies can’t charge you more, but your employer can, Stegemann says.
For instance, some companies will create a program that basically taxes you for certain bad habits, he says. You might pay more for health insurance if youre a smoker or if you are obese.
Such programs arent common, but theyre becoming more so, Stegemann says. We are hearing of more and more of it over the last five years, he says.
Stegemann believes employers have the right aim in mind, but theyre going about it the wrong way.
They basically are wanting you to be healthy, but they don’t give you the tools to do it, he says, adding that many plans dont cover you for things like obesity medications or surgery or even a gym membership.
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Does Bariatric Surgery Insurance Have A Waiting Period
Yes, bariatric surgery in health insurance has a waiting period of usually 2 to 4 years. Which means, if you want to cover your expenses for bariatric surgery you will have to wait for 2 years from the start of your policy. So, it is always advisable to opt for such a benefit with your first health insurance policy itself.
Is Weight Loss Covered By Insurance
A new weight-loss drug called Wegovy has shown promise, but there are questions as to whether health insurance companies will cover the prescription drug.
People who are obese have new hope of losing weight, thanks to a drug called Wegovy. Studies have found that patients who use the medication lose an average of 15% of their body weight when receiving weekly injections of the medicine.
Its fantastic, says Dr. Lloyd Stegemann, a member of the board of directors of the Obesity Action Coalition and the director of metabolic and bariatric surgery at Bay Area Hospital in Corpus Christi, Texas.
He adds that the results from Wegovy are not yet up to surgery, but they are getting closer in terms of what were seeing in terms of surgical weight loss, at least with our simplest procedures.
But the drug can cost as much as $1,500 a month. So, the question is: Will health insurance companies cover the cost of Wegovy? And do they pick up the tab for other forms of obesity treatment?
Read on to find out about treatments for weight loss covered by insurance.
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Complete List Of Insurance Companies & Bariatric Policies
The table below lists ALL health insurance companies in the United States along with the following:
- Link to bariatric surgery insurance coverage policy: the presence a link to your insurance companys policy does NOT confirm whether or not you have coverage.
- Link to insurance company contact info: Weve found your insurance companys contact info for you so you dont have to go digging for it.
Ask Your Surgeon for a Free Insurance Check: Most surgeons will contact your insurance company for you for free to confirm your bariatric surgery insurance coverage.
to contact a local surgeon to ask for your free insurance check.
Insurance And Bariatric Surgery: How To Navigate Your Benefits
After exploring your options and deciding that bariatric surgery is right for you, youll want to know how it will be paid for. Many insurance companies recognize the seriousness and health consequences of obesity and cover weight loss procedures provided you meet plan-specific qualification criteria.
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Find A Weight Loss Surgeon
- You can ask a local bariatric practice for a free insurance check or cost quote
- You can attend a free in-person seminar or an online webinar offered by a local weight loss surgeon
- You should schedule a phone or in-person consultation , if you are interested in learning more about weight loss surgery
Insurance Companies That Cover Bariatric Surgery In The United States
Almost all insurance companies in the U.S. have policies that cover bariatric surgery. Whether you have insurance that covers bariatric surgery depends on what type of policy you have:
- An Individual/Family or Small Group Policy covers weight loss surgery if you live in one of the 23 states that mandate it
- A Large Group Policy covers bariatric surgery if your employer has chosen to include it in your plan
- Medicare covers weight loss surgery
- Medicaid covers weight loss surgery
If your insurance policy covers weight loss surgery, insurance will only pay for it if:
- You have a qualifying body mass index of 35+ with obesity-related health problems or a BMI of 40+
- You participate in a medically supervised diet program before having the procedure
Scroll down for the full bariatric surgery insurance coverage list by U.S. Insurance company.
For more information about plan types and general bariatric surgery insurance qualification requirements, see our Bariatric Surgery Insurance page.
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Insurance Coverage Varies For Weight Loss Surgery Procedures
Insurance that covers bariatric surgery in ohio. This is the medical billing code for gastric bypass surgery. Come to one of our free weight loss seminars hosted by our expert bariatric surgeons. The patient still meets the medical necessity criteria for the bariatric surgery
However, the criteria below still need to be met: Prosper, which was founded in 2005 and has successfully assisted countless patients at bariatric associates, p.a. Patient/insurance coordinator department without cost to you will verify your insurance coverage and advice you if your insurance covers the gastric sleeve surgery.
In stegemanns experience, health insurance companies that cover bariatric surgery will pay the claim if the surgery is medically necessary and the patient meets all the criteria. These are a list of cpt codes for bariatric surgery. Yet we also offer among the lowest prices in the state:
Please note that bariatric surgery is not eligible under the financial assistance or discount programs offered by mercy, such as our hospital eligibility link. For example, the state of virginias medicaid program often refers patients for bariatric surgery. It is crucial that you call your insurance provider to determine if your policy covers surgical weight loss.
Contact your insurance carrier to determine if elective bariatric surgery is a covered benefit through your plan, he said.
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Will Health Insurance Pay For Bariatric Surgery
Health insurers generally pay for bariatric surgery if you meet requirements.
ASMBS said the most common reasons that patients don’t undergo laparoscopic gastric bypass surgery are insurance denial and not getting pre-authorization before the procedure. Insurers deny about 25% of patients considering bariatric surgery three times before giving approval. If you’re considering bariatric surgery and want your health insurance to pay for it, you may have to jump through a few hoops.
Perugini, though, said don’t let insurance scare you away from the procedure.
“”In the vast majority of cases, insurance covers bariatric surgery. Contact your insurance carrier to determine if elective bariatric surgery is a covered benefit through your plan,”” he said. “”And if your case is denied by insurance, there is an appeals process.””
Know your policys terms before scheduling bariatric surgery. Is obesity surgery specifically excluded in your policy? Do you need pre-authorization?
Your insurer will likely require a full medical work-up along with the pre-authorization request. Theyll also probably want documented physician-supervised weight-loss attempts. Insurers rarely cover weight-loss programs themselves programs like Weight Watchers and Jenny Craig don’t count.
Coverage for weight-loss surgery varies widely, as do insurers’ definitions of “”medically necessary.”” Here’s information from two major insurers — Aetna and CIGNA.
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