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 register for our Free Educational Seminar via the form here. Once we have reviewed your information and are able to verify your insurance, a team member will contact you to set up an appointment for an evaluation and your schedule your educational seminar. You will be required to complete this seminar, either in-person at our facility, or online, to proceed to the next step.
The evaluation appointment is scheduled for about two weeks after we call you. After that visit, you will be scheduled for:
We will screen your health history to make sure you are an appropriate candidate and our Insurance Team will make sure you meet the criteria set forth by your insurance policy. Assuming you meet all criteria, we will call to schedule your first appointment, where you will receive a personalized benefits form that will estimate, to the best of our abilities, your total out-of-pocket expenses. You will also need to complete a seminar, either in-person at our facility, or online.
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.
Most insurance companies require a medically supervised weight loss program no matter how many co-morbid diagnoses you have.
YES… the medically supervised weight loss program 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 program.
This is a question that is asked a lot… sometimes additional testing is required, one primary care provider may get the documentation back faster, or if your friend has a different insurance than you, maybe you were required to do a weight loss program 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.
Usually the weight loss program must be from 3 to 6 full months, which is one initial visit and 3 to 6 follow-up visits. Your appointments must be consecutive and the program must be successful, meaning your end weight must be the same or less than your start weight.
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.
Some patients may be able to discontinue or decrease use of 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 call the clinic at 575-556-1849.
Ready to take the next step in your weight loss journey?
Get started by registering for our free online seminar or give us a call at 606.451.4011.