The process leading up to bariatric surgery varies depending on each person’s medical history and insurance requirements. Please review the process below for additional information.
Please contact us directly or ask your provider to send a referral to our weight loss program to begin the process to bariatric surgery. One of our staff will complete a screening with you to determine candidacy for bariatric surgery.
If an individual is a candidate for weight loss surgery, the patient is scheduled for an online information session and sent an educational video to view. This virtual information session includes presentations by several members of our team, including a surgeon, dietitian, psychologist and nurse.
Once you have attended an information session, your file is active. We will need to collect the following records from you before you are seen by the surgeon for a consultation:
Your medical file will be sent to the surgical clinic for review and you will then be scheduled for a consultation with one of our bariatric surgeons for surgical clearance. Once cleared, we will submit to your insurance company for approval. Upon approval, your preoperative appointments and surgery will be scheduled.
For commercial insurance policies: Contact the customer service number on the back of your insurance card and ask this question exactly: “In my certificate of coverage, are there benefits for weight loss surgery for morbid obesity if medically necessary?”
For Medicare and Medicaid: There are benefits for weight loss surgery as long as the criteria is met. There is no need to contact Medicare and Medicaid. Once you are actively moving through the process and have shared your insurance information with our team, representatives from the hospital and surgical clinic will contact you with an estimate of costs.
Most insurance plans require that your BMI be 35 or higher. However, if your BMI is between 30 – 35, many insurance providers will also accept/cover services if you have a life-threatening medical condition, such as high blood pressure, diabetes or sleep apnea.
For commercial insurance policies; Contact the customer service number on the back of your insurance card and ask this question exactly. “In my certificate of coverage are there benefits for weight loss surgery for morbid obesity if medically necessary?”
For Medicare and Medicaid; there are benefits for weight loss surgery as long as the criteria is met. There is no need to contact Medicare and Medicaid.
Usually the diet is set by insurance for a specific timeline (i.e. 6 months). Check with your insurance company to clarify specific guidelines for your policy.
Most insurance companies that require a diet still require the diet no matter how many co-morbid diagnoses you have.
YES… the diet is part of criteria set by your insurance company. Your physician can write you a letter of support which will assist in obtaining approval, but you still have to complete the diet.
This is a question that is asked a lot… sometimes additional testing is required, one primary care may get the documentation back faster, or if your friend has a different insurance than you, maybe you were required to do a diet and your friend was not. If the insurances are different, then it may be because one insurance just takes longer to process than the other.
This means that your particular plan does not have benefits for weight loss surgery, no matter if you meet the medical necessity requirements or not. Your insurance may tell you that you have appeal rights, keep in mind that you will be appealing policy and not medical necessity. If there are no benefits for weight loss surgery it basically means that the benefit was not purchased by your company.
We do offer bariatric surgery for patients who would like to pay out-of-pocket. Please contact us directly for a quote.
Many patients are able to stop using some medications such as those for diabetes or high blood-pressure if these health issues are directly related to their weight. It is recommended that bariatric surgery patients maintain a vitamin regiment indefinitely after their procedure.
Please send an email to FRYE.SWL@lpnt.net.