Fast Track Program

We offer a Fast Track program for patients who have prior approval for a consultation from their insurance company or who plan to pay for their bariatric procedure with cash. Our expert team will meet with the patient and carefully review their medical history to determine which surgical procedure is best suited to meet their goals.  For more information about our  Fast Track program, please contact us by dialing 262-2330 or fill out the pre-consult packet.

Does my insurance cover bariatric surgery?

If you have a copy of your policy:

• The sections that outline the extent and limits of your insurance coverage usually appear under the headings "What is Covered" or "Covered Expenses". These are the expenses that the insurance company will pay. 
• The other sections to check are "What is Not Covered" or "When the Plan Does Not Cover Benefits".
• Look for any reference to exclusion of coverage for weight control, for the treatment of obesity, for surgical weight control, or for the complications of weight control or weight control surgery.
• Some insurance policies will not cover any bariatric surgery. Other plans may have restrictions about which surgeries and what they will cover. Look for statements such as "Surgery for the treatment of obesity is covered when deemed medically necessary." Or "Surgery for the treatment of obesity is (specifically) excluded, except when medically necessary." 
• If the surgery is covered when medically necessary, then you will receive bariatric surgery insurance coverage if you meet national guidelines for the care of morbid obesity.  (BMI calculator)
• You may also get partial coverage - this can include: tests, or by having another approved abdominal surgery done at the same time, thereby covering some of the hospital and anesthetic fees.

If you do not have a copy of your insurance policy:

• Contact the Human Resources department of the employer which provides your coverage, or call your insurance carrier. You should have your I.D. number and Group Number available for these calls.

What if I am on Medicare?

Medicare beneficiaries, including those over the age of 65, are covered for the Adjustable Gastric Band and Gastric Bypass procedures as long as they meet the normal criteria for surgery. However, the Medicare beneficiary's procedure of choice must be performed at either an American Society for Bariatric and Metabolic Surgery (ASMBS) accredited Center for Excellence or an American College of Surgeons (ACS) Level I Bariatric Surgery Program. If your facility is not accredited by either of these bodies, payment for the procedure may not be made by Medicare. Check with your surgeon's office before you schedule any procedure.

Bariatric Surgery Insurance Authorization Requirements

Prior authorization from your insurance company is normally required for weight loss surgery. You will likely need to send a "Letter of Medical Necessity" and personal weight loss history stating why significant weight loss is medically critical for you. This letter usually includes:

• Your weight.  You should be at least 100 pounds overweight; a BMI of at least 40; or a BMI of 35+ with a weight-related medical condition. Click here to check your BMI.
• A list of serious medical conditions associated with obesity such as Type 2 diabetes, sleep apnea, hypertension, acid reflux, or any other condition from which you suffer.
• Psychological evaluation. Your bariatric clinic will either provide this service or refer you to a psychologist.
• The number of years that you have been overweight (which should be at least five years).
• The number and type of failed weight loss and exercise programs you have tried in the past, including physician supervised programs.

Document: Insurance Authorization Criteria by Provider

A good way to improve your chances of being approved for bariatric surgery insurance coverage is to create a document or package listing all your previous weight loss attempts (on your own or with medical supervision), and the results. You should include any commercial diets that you've been on, as well as medical records that document your weight loss efforts.
Follow up to make sure your insurance company received the materials.  Sometimes, things do not progress as rapidly as you might hope, so you will need to be patient and persistent.

What if I am denied bariatric surgery insurance coverage?

If you are denied bariatric surgery insurance coverage, don't be discouraged, and don't be afraid to contact your insurance provider and ask questions.  You may want to follow these steps:

• Determine why bariatric surgery is not a covered benefit. Ask your insurance provider for specific reasons.
• Insist on a written denial.
• Ask for your request to be reconsidered. Call the member services phone number on your insurance card. If the request will not be reconsidered, ask for the steps required to file an appeal.
• File your appeal. You may want to consider working with your bariatric practice to discuss the next steps in appealing for coverage. They can help you navigate the appeal process.
• Contact your insurance provider to confirm they have received your appeal.
• Notify your surgeon's office after your appeal has been submitted so it can be recorded in your chart.
• Follow up with your insurance provider about three weeks after filing your appeal.

What if my appeal is denied?

If your appeal is denied, you may want to consider alternative financing options.  These range from cash payment to obtaining a loan from an outside resource.