Tuesday, April 16, 2024

Self-pay Insurance That Covers Bariatric Surgery

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How to Self-Pay for Bariatric Surgery: 8 options to help you cash pay for surgery.

SECTION SUMMARY:

  • You can ask a local bariatric practice for a free insurance check or cost quote
  • You can attend a free in-person seminar or an online webinar offered by a local weight loss surgeon
  • You should schedule a phone or in-person consultation , if you are interested in learning more about weight loss surgery

A Discussion Of Your Insurance Options

At some point, after you have spent a considerable amount of time exploring the option of weight loss surgery, 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 benefits for weight loss surgery for patients that meet the National Institutes of Health surgical criteria. And while insurance coverage for weight loss surgery is widespread, it often requires a lengthy and complicated approval process. The best chance for obtaining approval for insurance coverage comes from working together with your surgeon and other experts.

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Weight Loss Surgery Insurance Secrets

When you have made the big decision to achieve permanent freedom from obesity, nothing should come in your way to qualify for weight loss surgery insurance. However, in reality, many patients experience challenges in getting approvals or face claim denials from their insurers. Here are five proven weight loss surgery insurance secrets that will help you obtain approval for maximum coverage from your insurance company.

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How Long Does It Take Medicaid To Approve Weight

Medicaid also allows weight-loss surgeries if you meet criteria, but recent studies show approval make take longer.

Insurers usually take a month to approve weight-loss surgeries. However, wait times for Medicaid approval can take five months or more. During that time, Medicaid will review your records and input from your doctor before making the decision.

How To Get Insurance To Pay For Bariatric Surgery By Demonstrating Medical Necessity

How to Pay for Bariatric Surgery Without Insurance

Most insurance plans require that medical necessity be demonstrated before coverage is granted for weight-loss surgery. This means that in addition to your consultation with them, youll need to provide evidence that bariatric surgery is necessary for each patient. The exact criteria vary from one insurance provider to the next but typically include the following.

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Bariatric Surgery: The 12 Most Important Reasons People Self Pay For Their

Bariatric surgery can be expensive, but they can also be very beneficial. Some people choose to self-pay for their bariatric surgery because they want to take control of their health in a way that insurance companies dont always allow. They may also want to avoid getting a second opinionfilling out all the paperwork to get approval for the procedure from their insurance company. It would be best if you did not worry Dr. Jay Suggs at Alabama Bariatrics got you covered.

Here are reasons why some people self-pay for their bariatric surgery:

Body Mass Index Above 40

Most insurance companies will require that patients have a body mass index of 40 or above to be candidates for bariatric surgery.

Alternatively, patients with moderate obesity may be candidates for bariatric surgery if they have a BMI of at least 35 and there are co-morbidities present such as high blood pressure, type 2 diabetes, clinically significant obstructive sleep apnea, coronary heart disease, or hypertension.

Some insurance companies may require your patient to be moderately or morbidly obese for a particular duration of time before surgery is approved.

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If Your Policy Does Not Cover It: Seek Partial Coverage

You may be able to get part of the costs paid for by insurance even if weight loss surgery isnt covered. Its all about how your doctor and hospital submit your claims to your insurance company.

For example, there are many non-bariatric surgery reasons for your doctor to recommend:

  • Cardiology exam
  • Psychological exam

These are ordered for many reasons other than bariatric surgery and may be covered as a result. If your doctor submits one of these claims using a weight loss surgery CPT code , your insurance is unlikely to cover it. But if your doctor uses a general CPT code, it probably will be covered.

While this may sound sneaky, it is an ethical practice. After all, these tests will be beneficial regardless of whether you move forward with surgery.

Cost Of Bariatric Surgery

Gastric Sleeve Insurance vs Self Pay

For many people, bariatric surgery is affordable because it is covered by their health insurance plan. People who do not have insurance coverage for bariatric surgery must pay for it on their own. This is called self-pay or cash-pay. Even without insurance, many people feel that the surgery is worth the investment in their health and seek out alternative financing options.

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Will Health Insurance Pay

If you have health insurance, read your policy carefully, and work closely with your insurer and your doctor to see what’s covered. Under the Affordable Care Act, some states require that health insurers selling plans in the Marketplace or directly to individuals or small groups cover bariatric surgery by 2016 nearly half of states mandated coverage for these plans.

Most insurance companies recognize that people who are overweight and obese are more likely to get serious health conditions such as type 2 diabetes, high blood pressure, heart disease, high cholesterol, and sleep apnea.

If you donât have health insurance, have insurance through a large employer , or you live in a state that does not include bariatric surgery in its essential health benefits, youâll likely have to pay the entire bill yourself. Some weight loss surgery centers can help you get a loan that you can repay over a number of years.

Should I Pay In Cash Or Use Insurance

When considering getting a bariatric procedure done, insurance is the ideal way to go. However, whether you should pay out of pocket or through insurance will depend on the type of policy you have. Today, most major insurance carriers cover laparoscopic gastric bypass, gastric sleeves, and lap band surgeries. However, that does not mean your health plan also provides coverage for such procedures.

While some plans entirely exclude bariatric surgery, others may require you to pay more to include coverage for weight loss procedures, Read your individual health policy carefully or ask your agent to know whats covered and whats not.

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Insurance & Financing Information

For many people, gastric bypass surgery is affordable because it is included in their health insurance coverage. For other people, bariatric surgery is a medical treatment they pay for themselves, called self-pay or cash pay. Many people who have had surgery feel that even without insurance, the surgery is worth it. They look at it as an investment in their health.

Whether your insurance company will cover the cost of bariatric surgery or you are paying for it yourself, you will need to prepare detailed written documentation to support the medical necessity of your surgery. Thorough documentation of previous unsuccessful dieting attempts, including medically supervised attempts, co-morbid conditions, and other factors, such as the medications you’re currently taking, can help document that bariatric surgery is necessary for the treatment of your morbid obesity.

How Can They Deny Insurance Coverage For A Life

Gastric Bypass Surgery Costs

You may have a specific exclusion in your policy for obesity surgery or treatment of obesity, which reflects the prejudice of our society toward obesity. This exclusion normally cannot be challenged or overturned. You may be able to get an exception by going through your employers benefits division.

Coverage may also be denied for lack of medical necessity, meaning its not deemed a serious or life-threatening condition. Instead, alternative treatments, such as dieting, exercise, behavior modification, and some medications, may be considered to exist according to conventional wisdom. To avoid denials for this reason, be sure to include reasonable, thorough documentation to encourage them to approve your request.

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If Your Insurance Is Through Work: Large Group

If you get your insurance through your work and your employer has 51 or more full time employees, it is completely up to your company to decide whether or not to cover weight loss surgery.

To confirm your coverage, you have a three options:

  • Option 1 : Your local surgeon will contact your insurance company to confirm your benefits for free. Their office will be very familiar with your insurance companys requirements and approval process, so its usually a good idea to let them do the leg work for you. .
  • Option 2: Ask your Human Resources Department whether or not weight loss surgery is an included benefit under your plan.
  • Option 3: Contact your insurance company yourself and/or check your Summary Plan Description . for the full list of United States insurance companies, contact information and bariatric surgery coverage policy details.

If you find out that bariatric surgery insurance is NOT included under your plan, you may want to head over to our Weight Loss Surgery Insurance Secrets page to learn how you may be able to get your company to add the coverage.

If you have short term disability insurance through your employer, you may be able to receive portion of your monthly salary while youre having and recovering from surgery. See our Short Term Disability section for more information.

Other Ways To Pay For Weight Loss Surgery

If you do not have health insurance, or if your insurer will not cover weight loss surgery, talk to your doctor and your surgeon about financing plans. Check on the interest rate, and make sure you are OK with all of the terms.

Show Sources

Anita Courcoulas, MD, MPH, chief of minimally invasive bariatric and general surgery, University of Pittsburgh School of Medicine.

American Society of Plastic Surgeons: “Insurance Coverage: A Patient’s Guide.”

American Society for Metabolic and Bariatric Surgery: “Metabolic & Bariatric Surgery.”

WebMD Medical Reference: “Preparing for Weight Loss Surgery” and “Your Options in Weight Loss Surgery: Making the Choice.”

National Conference of State Legislatures: “Health Reform and Health Mandates for Obesity.”

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Insurance Review: Approved Or Denied

After you complete the pre-surgery testing process, and you submit your documentation, your insurance provider will review your application and send you an approval or denial letter. If your surgery is approved, we will contact you to schedule your surgery.

If you are denied, dont lose hope! We will help you follow up with the insurance provider to clarify any questions or any reasons listed for denial.

Paying For Your Bariatric Surgery

PAYING FOR WEIGHT LOSS SURGERY | Breaking Down the Cost of Bariatric Surgery

The cost of bariatric surgery depends on your insurance coverage and the procedure performed. Generally speaking, a patient paying cash for a procedure will pay between $12,500 and $31,000.

Most insurance companies and Medicare cover bariatric surgery however, every plan differs. We will help you verify that your benefits include bariatric surgery, and we will help you determine what, if any, co-payments and deductibles you will be responsible for.

While Medicaid is accepted at both locations, it does not cover all costs. As with all medical procedures, it is important to understand what will and will not be covered by your individual plan. If you do not see your insurance here, please contact our office, as contractual arrangements are subject to change.

  • ASR Physicians Care
  • Blue Care Network Medicare Advantage
  • Blue Cross Blue Shield Traditional
  • Blue Preferred PPO/Community Blue PPO
  • Priority Health Medicare
  • United Healthcare
  • Traditional Medicare

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Contact The Center For Metabolic And Obesity Surgery

At The Center for Metabolic and Obesity Surgery, located in Altamonte Springs, Florida, we offer a proven, multifaceted approach to metabolic and bariatric surgery that will empower you to achieve your weight loss goals, improve your health and appearance, and rebuild your self-confidence. Led by esteemed, Board Certified surgeon Dr. Wiljon Beltre, one of the only fellowship-trained bariatric surgeons in Central Florida, we specialize in the latest cutting-edge procedures for safe, effective surgical weight loss coupled with a dedicated support team of caring, experienced specialists who will stand by your side to support you throughout your entire weight loss journey. Significant weight loss is not easy, but with the help of with our confidential consultation and education process, the surgical skill and experience of our medical team, and the advice and guidance of our ongoing support network, we can help you achieve the lasting weight loss success you have been dreaming about.

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Option #: Crowd Funding

Currently, there are many crowdfunding sites that can help you accomplish this. You might need to put some effort into the campaign in order to convince strangers of why you need the surgery and why they should help you pay for it.

This approach is also very good for accountability. Imagine if 1,000 strangers donated money to put you through surgery and then you dont put any effort into the weight loss process. You are going to disappoint a lot of people.

Also, you are gonna have to open up your personal life and struggles to the world in order to get people to donate to your campaign. Why is this important you may ask?

Well, weight loss surgery is a mental endeavor. One of the most important parts in my opinion is to embrace how you are and how you got to were you are. That is the first key step in weight loss surgery success. In order to make a change, you need to know what to change.

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The Cost Of Gastric Sleeve Surgery

For most individuals, the cost of gastric sleeve surgery is determined by their insurance plan. At BMI of Texas, our services are in-network with most major insurance providers. We also provide additional, employer-based coverage to many local employers in the San Antonio area. Your exact insurance plan will determine what portion, if any, of your hospital bill will need to be paid out-of-pocket.

The cost of gastric sleeve surgery can vary dramatically around the country, as well. Here in San Antonio, we are proud to offer the highest-quality services at a fraction of the cost of the exact same surgery in Los Angeles, New York, and other metropolitan areas in Texas.

No Insurance Purchase Bliscare Insurance

Bariatric Insurance Coverage

Our program strongly recommends against having any surgical procedure without proper insurance coverage.

If you don’t have health insurance and are paying for bariatric surgery on your own, you must purchase BlisCare insurance.

All of our self-pay patients are required to purchase BlisCare insurance for their financial protection.

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Bariatric Surgery Self Pay Package Includes:

  • Consultation Surgeons Fee
  • Center of Excellence Facility Fee
  • Extensive Pre-Operative Nursing Education
  • Pre-Operative Nutritional Education
  • Post-Operative Support including access to Bariatric Registered Nurse, monthly Bariatric Support Groups, Back on Track Program, monthly Nutrition Support Groups, two private Nutritional consultations
  • Phone access to Dr. Wizman pre and post operatively
  • First Lap Band Adjustment

Option #: Life Insurance Policy Loans

Life insurance loans in a whole life policy, for example, offer several advantages.

  • Quick access to the cash.
  • No loss in opportunity cost because the money still invested. You get a loan with the cash value as collateral.
  • Usually low interest.

Again consult with your financial advisor or insurance agent before considering this option.

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Does Medicare Cover Bariatric Surgery

Medicare covers some weight-loss surgeries, including laparoscopic banding surgery and gastic bypass surgery.

You need to meet requirements and deemed severely obese. You and your doctor need to get pre-approval for weight-loss surgery.

Similar to other insurers, Medicare will likely require a BMI of at least 35, your weight must also be causing serious health issues and youve attempted for years to lose weight through diet and exercise.

Weight Loss Surgery Is Subject To Strict Insurance Requirements

Does your insurance cover Bariatric surgery, and if not, what are the options?

Many insurance companies have strict requirements for approval of weight loss surgery. Cost can be one factor, but its not the only one. For example, many insurance companies need you to consider BMI over 30 for weight loss surgery. If you have a BMI of 27, you may not be able to get coverage through your company. If you want to pay out-of-pocket, you may need to wait until your BMI exceeds the threshold.

Theres also the cost issue: Many insurance companies wont cover weight loss surgery unless necessary or if its part of your treatment plan for another condition . If your insurance doesnt cover this procedure, youll have to pay out-of-pocket for itwhich can cost thousands of dollars.

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What Can I Do To Ensure Approval

Before your consultation, youll be given a patient health history questionnaire. Its important to fill this out truthfully and completely because it will be translated into your medical record, which will be reviewed by the insurance company.

If you have any documentation of your previous attempts at weight loss whether by diet, exercise or medical supervision, bring a copy to be reviewed and scanned into your chart.

If youve had a previous weight loss procedure, you should obtain copies of your operative report as well as pre- and post-op visits to demonstrate your committed follow-up and compliance with any recommendations that were made by your former provider.

The single most important thing that every patient should do to ensure the likelihood of approval by their insurance company is to remain in full compliance with the requirements set forth in the medical policy . Medically supervised diets often must occur in consecutive months and should be spaced out by approximately 30 days. Failure to keep scheduled appointments in consecutive calendar months will often result in denial and may delay surgery or cause you to have to re-start the prescribed program from the beginning.

The MultiCare Center for Weight Loss & Wellness supports you before, during and after the weight loss journey.

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