Insurance and Payment for Your Weight-Loss Surgery
Insurance Considerations for Patients Considering Weight Loss Surgery
Most patients have health insurance benefits, which allow coverage for bariatric surgery. These benefits should cover at least a portion of the surgery expenses for morbid obesity. However, you should be aware that there are often out-of-pocket expenses, depending on the choice of procedure and your insurance company’s policy. These out-of-pocket expenses can range from as low as $5.00 to more than $30,000. To avoid misunderstandings, we strongly encourage you to work with our insurance experts to try to determine your out-of-pocket expenses.
The following is a list of insurance companies and their current policies on weight loss surgery. These policies can be changed by the insurance companies at any time, therefore please use this table only as a guide. Our insurance office will check for changes in these policies at the time they submit your authorization request.
| Insurance Company |
Procedure |
Approval Criteria |
| Blue Cross |
-Roux en Y gastric Bypass
-Duodenal Switch |
BMI >40 or >35 with Medical problems |
| Blue Shield |
-Roux en Y gastric Bypass
-Vertical Gastrectomy (for special indications) |
BMI > 40 or >35 with Medical problems |
| HealthNet |
-Roux en Y gastric Bypass
-Duodenal Switch
-LapBand® |
BMI > 40 or >35 with Medical problems |
| United Healthcare |
-Roux en Y gastric Bypass
-Duodenal Switch-Vertical Gastrectomy
-LapBand® |
BMI > 40 or >35 with Medical problems |
| Aetna |
-Roux en Y gastric Bypass
-LapBand® (for special indications) |
-BMI > 40 or >35 with Medical problems
-3-6 month MD supervised Diet |
| Cigna |
-Roux en Y gastric Bypass
-LapBand®(for special indications) |
-BMI > 40 or >35 with Medical problems
-6 month MD supervised Diet |
For patients who do not have insurance that will authorize weight loss surgery we do have a self pay option. Contact our main office toll free at 866-957-3627 and ask for Amy or Anne. Difficult insurance questions will be referred on to our insurance experts.
Can I Self-Pay for my Weight-Loss Surgery?
The simple answer is yes. However, most insurance companies
do authorize weight loss surgery and we have a very high success
rate at authorizations. We are able to get most insurance companies to authorize and pay
for most of the hospital charges and some of the surgeon fees.
Our preference is for you to use your insurance to avoid the significant
hospital and other related costs. If you need to self pay, please
email your request to us at weightloss@lapsf.com and include your
contact phone number. We will contact you to discuss this issue.
Please be aware that most insurance companies do authorize the
Gastric
Bypass, fewer authorize the Duodenal
Switch, and LapBand®, and the Vertical Gastrectomy.
Contact us to schedule a one-on-one consultation with an experienced weight-loss surgeon. Call and speak with one of our weight-loss surgery specialists today toll free at 866-957-3627.
Links to sites which can help you with insurance issues:
In most states, review boards can - and often do - overturn an insurance company's denial for surgery.
The Department of Managed Health Care - This is the department of managed health care website. Advice on how to seek an independent medical review (IMR) can be found here. You can also search a database on morbid obesity to see what appeals were upheld and which ones were overturned.
www.kff.org
patientadvocate.org
www.hrh.org
moneycentral.msn.com/articles/insure/health/contents.asp?p=2
moneycentral.msn.com/articles/insure/basics/9962.asp
Contact us via email or phone or register for an appointment.
Read about the Roux En Y Gastric Bypass, laparoscopic surgery, obesity
help, and weight-loss surgery.
