INSURANCE COVERAGE AND REQUIREMENTS
Insurance coverage varies for weight loss surgery procedures. It is crucial that you call your insurance provider to determine if your policy covers surgical weight loss. As an integral part of our team, the insurance coordinator can answer questions and give you guidance when working with your insurance company to acquire approval to undergo one of the surgical weight loss procedures.
Insurance companies often require medically supervised diets than can span up to 6 months. If this is the case with your insurance and you do not have prior documentation, you will be required to obtain this information before our insurance coordinator will send your paperwork for approval.
We understand the importance of surgical weight loss procedures and will work with you every step of the way. If your insurance company denies the request for coverage of your weight loss surgery procedure, our insurance coordinator will discuss appeals and self-pay options with you.
Some insurance companies will make the decision about your weight loss surgery within a few weeks. Some insurance carriers take several weeks or months to return a decision. We will contact you when we have heard from your insurance provider. You may contact your insurance company to check on the status of your insurance approval as well.
Important Questions to Ask Your Insurance Provider
There have been times when inaccurate bariatric coverage information has been provided by the insurance provider to our office. We encourage all our patients to contact their insurance provider and ask the following questions regarding their coverage:
- Do I have coverage for weight loss/bariatric surgery? Provide them with the diagnosis code E66.01.
- What are the criteria for surgery?
- BMI (body mass index)
- Co-morbidities – how many and which medical conditions qualify
- How many months of medical weight management are required prior to surgery?
- Is my insurance plan self-funded?