Payment & Insurance Options
At some point you will need to determine how to pay for the procedure. A growing number of states have passed legislation that requires insurance companies to provide weight-loss surgery benefits to patients who meet the surgical criteria established by the National Institutes of Health.
While insurance coverage for weight loss surgery is widespread, it often requires a lengthy and complicated approval process.
Here are some of the key steps you should take to obtain insurance coverage for weight loss surgery:
- Read and understand the "certificate of coverage" that your insurance company is required by law to give you. If you do not have one, consult your company's benefits administrator or ask your insurance company directly.
- You may be required to start with your primary care physician. In some cases, he or she is the only one you can ask for a referral to a qualified bariatric surgeon. Even if you are not required to get a referral, it is a good idea to have the support of your primary care physician.
- Before visiting the bariatric surgeon, organize your medical records, including your history of dieting efforts. They will be valuable documents to have at every stage of the approval process.
- Document every visit you make to a health care professional for obesity-related issues or visits to supervised weight loss programs. Document "other" weight loss attempts made through diet centers and fitness club memberships. Keep good records, including receipts.
Thirty days is the standard time for an insurance provider to respond to your request. You should initiate a follow-up if you have not heard from your insurance company in that time.
We Are Here to Help
We accept most insurances. We will verify your benefits to ensure coverage and review your plan requirements at your first visit. We will submit your documentation to your insurance company for approval. Requirements for approval depend on your policy.
- BMI >40 or >35 with significant co-morbidities.
- Documented history of medical weight loss attempts (3-6 months, some 1 year).
- Psychological evaluation and nutrition counseling.
We also offer self-pay to patients for the Sleeve Gastrectomy procedure.
For more information about insurance verification or self-pay options, call (402) 354-1320.
The Appeals Process
Even if your initial request for pre-authorization is not approved, you still have options available. Insurers provide an appeal process that allows you to address each specific reason they have given for denying your request. It is important that you reply quickly. It is also recommended that at this point you enlist the help of an experienced insurance attorney or insurance advocate to properly navigate the complexities of the appeal process. Some insurers place limits on the number of appeals you may make, so it is important to be well prepared and clearly understand the appeal rules of your specific plan.