Insurance

Insurance Information

Am I a candidate for bariatric surgery?

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Below are tools you can use to determine if you are morbidly obese and potentially a candidate for weight loss surgery.

  • Your BMI (Body Mass Index) is 40 or more
  • Your BMI is 35 or more and you have one or more serious medical conditions associated with obesity such as diabetes, high blood pressure, or sleep apnea
  • You have been overweight for more than 5 years.
  • Your serious attempts to lose weight have had only short-term success.
  • You do not have any other disease that may have caused your obesity.
  • You are prepared to make substantial changes in your eating habits and lifestyle.
  • You are willing to continue being monitored by the specialist who is treating you.
  • You do not drink alcohol in excess.
  • You are not addicted to drugs or alcohol and you are clean and sober.

Does your insurance cover bariatric surgery?

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A growing number of states have passed legislation that require insurance companies to provide benefits for weight loss surgery for patients that meet the National Institutes of Health surgical criteria. Most insurance companies now cover weight-loss surgery. Each insurance plan has its own specific set of requirements. We do participate in a majority of insurance plans.

Here are some of the key steps you should take to see if you have insurance coverage for weight loss surgery:

  • Contact your insurance company by calling the customer service phone number on the back of your insurance card to ask if you have bariatric coverage in your policy
  • Your customer service representative through your insurance carrier will be able to provide details about whether or not your have out-of-pocket expenses.
  • 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.
  • Your Primary Care Physician may need to provide you with a referral based on your type of insurance policy. Even if you are not required to get a referral, it is a good idea to talk with your primary care physician.

How does Tri-State Bariatrics help with insurance?

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We have dedicated staff members to assist you. At your first formal office visit our Insurance Liaison will confirm that bariatric surgery is a covered benefit under your specific insurance plan. She will also inform you at that time what tests or consultations are required by your insurance plan. These tests are commonly referred to as your pre-operative tests/consults.

Initially this list of tests/consults may seem overwhelming but we have dedicated staff members to help you navigate your way through this aspect of the process.
The Insurance Liaison will take care of submitting all of the required information to your insurance company.

This can only occur when:

  • All tests/consults are on record in the office.
  • Your surgeon has reviewed them with you and reviewed the risks & benefits of surgery.
  • A surgery date has been set between you and the surgeon.

Your insurance company then reviews all the information submitted and makes a determination. This is commonly referred to as the approval process. The approval process varies among insurance companies. Once formal approval has been received you will be notified.

If for any reason you are denied, we will work closely with you on the appeals process.

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