The Center for
Weight Management team does everything necessary to ensure
proper insurance information is listed on a patient's account
and benefits are properly coordinated. Some of the services
provided may be considered “non-covered” or
“exclusions” to your insurance policy. We will
make every attempt to notify you promptly before the services
are rendered. The financial counselor informs the patient
about the financial impact of treatment. Before treatment
begins, we will make a good faith attempt to provide the
patient with an accurate estimate of treatment costs that
may not be covered by the patient's insurance.
Financial counseling services are provided to our patients
here in our clinic. The financial counselor is responsible
for assisting all patients, staff, and physicians with needs
related to insurance.
Every patient
that is a candidate for surgery will receive a consultation.
During this period, the financial counselor will meet with
the patient one on one to discuss payment options. All patients
are encouraged to contact their insurance companies to obtain
information.
The information
that is provided to each patient is only an estimation of
benefits and not a guarantee of payment. The benefits obtained
from the insurance company are based on the level of coverage
during the time of verification. Please be mindful that
your insurance coverage can change without notice.
Patients that
are seeking bariatric surgery must have an identified financial
source such as insurance or other means to cover the cost
of care. It is ultimately the patient’s responsibility
to know their insurance coverage and limitations. This is
why we encourage every patient to call their insurance carrier
for coverage determinations.
Attention
Lap Band Patients
Most
insurance companies cover the Lap Band procedure and not
the actual Lap Band adjustments. Please verify with your
carrier what the guidelines are for coverage.
Insurance
Requirements
Here
is a list of general guidelines for coverage of bariatric
surgery as defined by some of the major insurance carriers.
These are only general guidelines that may or may not apply
to your particular medical insurance coverage. Most insurance
companies have requirements that must be satisfied which
will include the following:
Minimum age
of 18 or documentation of completion of bone growth
Body mass index
(BMI)* exceeding 40 OR
BMI*
greater than 35 in conjunction with one or more severe co-morbidities
which can include:
History
and physical with documented three to five year history of
morbid obesity
Documentation
of medically supervised non-surgical methods of weight reduction
by an MD, DO or nurse practitioner – that includes
nutritional, medication and/or maintenance therapy, behavior
modification, exercise or increase of activity.
*Depending
on your insurance, supporting documentation will have to
be provided that outlines your participation in a treatment
plan for a defined period of time. (i.e. Cigna, Blue Cross
and Blue Shield, and some Great West Healthcare plans require
6 months of conservative treatment whereas most Aetna and
American National insurance plans only require 4 months
of consecutive non-surgical treatment).
Psychological
evaluation by a licensed mental healthcare professional
that addresses the following:
-
Absence
of problems related to alcohol or substance abuse.
-
Absence
of major psychotic or disabling mental health diagnosis
-
Absence
of compulsive or obsessive-compulsive disorder.
-
Eating
disorders (i.e. bulimia)
Documentation
of willingness to comply with preoperative and postoperative
treatment plans.
Predeterminations
Once your insurance requirements have been satisfied, your
documentation will be reviewed again to make sure that all
diagnostic test and lab work have been completed. The surgeon
will give the clearance to proceed with predetermination.
The predetermination process can take anywhere from a few
days up to several weeks depending on your insurance provider.
Please feel free to contact your insurance company to check
the status of your request.
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