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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.
There are several ways to pay for weight loss surgery at Good Samaritan Hospital:
- We accept most insurance plans.
- As a Bariatric Surgery Center of Excellence, we are a provider for Medicare patients seeking bariatric surgery.
- Self-pay contracts are available for patients whose insurance companies list bariatric surgery as an exclusion.
The best chance for obtaining approval for insurance coverage comes from working together with your surgeon and other experts. Here are some of the key steps you should take to obtain insurance coverage for weight loss surgery:
- Read and understand the “certificate of coverage” that your insurance company is required by law to give you. If you do not have one, consult your company’s benefits administrator or ask your insurance company directly.
- You may be required to start with your primary care physician. In some cases, he or she is the only one you can ask for a referral to a qualified bariatric surgeon. Even if you are not required to get a referral, it is a good idea to have the support of your primary care physician.
- Before visiting the bariatric surgeon, organize your medical records, including your history of dieting efforts. They will be valuable documents to have at every stage of the approval process.
- Document every visit you make to a healthcare professional for obesity-related issues or visits to supervised weight loss programs. Document “other” weight loss attempts made through diet centers and fitness club memberships. Keep good records, including receipts.
- If your surgeon recommends weight loss surgery, he or she will prepare a letter to obtain pre-authorization from your insurance company. The goal of this letter is to establish the “medical necessity” of weight loss surgery and gain approval for the procedure.
Thirty days is the standard time for an insurance provider to respond to your request. You should initiate a follow-up if you have not heard from your insurance company in that time.
Note: Prior to submitting a request to your insurance carrier for approval, you will need to complete the following screening requirements:
- Attend a weight loss seminar.
- Meet with Dr. Kerlakian and a nurse.
- Complete a psychological evaluation.
- Attend a nutrition education class.
- Attend a Sit and Be Fit exercise class – an overview of the importance of exercise in the pre- and post-operative phases.
- Attend a support group meeting.
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