The process leading up to bariatric surgery varies depending on each person’s medical history and insurance requirements. First, please complete our online seminar. Access the Online Seminar here, enter your contact information and complete the online seminar quiz.
Once insurance review is complete a member of our staff will contact you to set up an appointment for an evaluation. When you attend a seminar at our facility, you will have the opportunity to speak with any number of our Bariatric Staff, including our Surgeon, Dr. Eric Smith; Heather Pile PAC Dietitian; and Insurance Coordinator, Jennifer Morris. Or, you can call us at 502.570.3727 to schedule a live seminar.
We realize that not everyone can arrange to attend a seminar in person, so we’ve developed an online version that delivers the same information. The online seminar is delivered by Dr. Eric Smith, and will take about 20 minutes to view.
The evaluation appointment is scheduled for about two weeks after we call you. It’s a group meeting with a nurse, dietitian, surgeon and insurance specialist. You’ll also have a one-on-one meeting with the physician assistant for an initial history and physical. After that visit, you will be scheduled for:
Our insurance team will verify if your policy has benefits for weight loss surgery. 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. Click here to begin our online seminar.
Most insurance plans require that your BMI be 35 or higher. However, if your BMI is between 30 – 35, we can sometimes get you approved 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 that require a diet still require the diet no matter how many co-morbid diagnoses you have.
YES… the diet 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 diet.
This is a question that is asked a lot… sometimes additional testing is required, one primary care may get the documentation back faster, or if your friend has a different insurance than you, maybe you were required to do a diet 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 diet must be for at least 6 full months, which is one initial visit and 6 follow-up visits. Your appointments must be consecutive and the diet 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.