Insurance & Financial Eligibility

Bariatric Surgery Insurance & Financial Eligibility

What steps can I take to ensure my insurance company covers bariatric surgery?

Questions Regarding Your Insurance?
If you have any questions regarding your bariatric surgery insurance coverage, please call toll-free 855-328-7483 or fill out the contact form highlighting insurance to speak with a Financial Counselor.

Bariatric surgery insurance coverage is offered through many major health insurance providers. In fact, a number of states have passed laws requiring insurance companies to include surgical obesity treatments such as laparoscopic Roux-en-Y gastric bypass, sleeve gastrectomy and adjustable gastric band surgery.

Do Medicare and Medicaid Cover Weight Loss Surgery?

Yes. Both Medicare and Medicaid provide coverage for bariatric surgery.

Because Medicaid is administered by individual states, coverage varies depending on where you live.

Under Medicare, Bariatric surgery is listed as a covered obesity treatment for patients who:

  • Have a sustained body mass index of 35 or greater
  • At least one obesity-related co-morbidity such as cardiovascular disease, Type-2 diabetes, peripheral nerve damage, or kidney disease
  • Have clear documentation in their medical records demonstrating they have been unsuccessful in achieving a healthy body weight through lifestyle modification and/or a medically supervised weight loss program

Note that Medicare does not cover the gastric balloon procedure.

Does Tri State Bariatrics Accept Bariatric Surgery Insurance?

Yes.

Here at Tri State Bariatrics we’re committed to helping you get the weight loss surgery you need to look and feel your best. We participate with most major insurance plans, including:

  • Affinity
  • Blue Cross Blue Shield
  • CDPHP
  • Cigna
  • Emblem Health – GHI and HIP
  • Fidelis
  • Medicare
  • MVP
  • Oxford
  • United Healthcare

* We are non-participating with the following plans:

  • Aetna
  • CRHC (Crystal Run Healthcare)

*If your plan has out of network benefits, please contact our billing team to discuss the process.  In most cases, your additional out of network costs will be minimal.

How Can I Get My Weight Loss Surgery Covered?

The criteria for coverage vary with each insurance company. Here at Tri State Bariatrics, we have extensive experience in working with bariatric surgery insurance.

Our dedicated Insurance Liaison specialist will help you understand what is covered under your current health insurance plan, confirm the documents and tests required by your provider, and help you navigate the complex and often confusing paperwork involved.

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.

Steps 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 you 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?

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 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.

Questions Regarding Your Insurance?

If you have any questions regarding your insurance, please call toll-free 855-328-7483 or fill out the contact form highlighting insurance to speak with a Financial Counselor.

Make an Appointment

Make your appointment today to find out if you have bariatric surgery insurance benefits. Call toll-free 855-EAT-RITE (845-286-8181).

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MIDDLETOWN
384 Crystal Run Road,
Suite 201
Middletown, NY 10941

(845) 692-8780

FISHKILL
200 Westage Business
Center Drive,Suite 119
Fishkill, NY 12524

(845) 896-0610

SLEEPY HOLLOW
777 North Broadway,
Suite 207
Sleepy Hollow, NY 10591

(845) 517-2870

SUFFERN
Airmont Professional Center
156 Route 59, Suite A2
Suffern, NY 10901

(845) 517-2870

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