Insurance & Payment Options Weight loss surgery, sometimes referred to as bariatric surgery, is not universally covered by insurance companies. However, many have begun offering coverage, and it’s important to contact the company and verify whether or not you have weight loss surgery financing coverage, and whether that coverage applies to surgery at Roller Weight Loss & Advanced Surgery. There are a variety of circumstances you may encounter regarding your health insurance:
- Your carrier offers no coverage. In this case, you will not be able to use insurance to help pay for weight loss surgery.
- The policy makes no mention of weight loss surgery (bariatric surgery). When the policy neither specifically covers nor excludes weight loss surgery, the company must be contacted for clarification. It is generally advised to speak to more than one representative, as some may not be able to speak with authority regarding coverage.
- Your carrier does not give a definitive answer regarding coverage. Some carriers will wait until documentation is received proving the medical necessity of the procedures, while others will immediately approve or deny coverage. We will work with you to satisfy your carrier’s requirements.
As you explore whether or not you have coverage, we will be available to answer any questions you may have about what to tell your carrier. Note: Obesity and morbid obesity are considered separate health conditions. Some plans exclude treatment for obesity but will cover treatment for morbid obesity. Be very specific when describing your condition to your insurance company. If you are unsure which condition you have, we can help you make that determination. Getting Approval Insurance companies that cover weight loss surgery (bariatric surgery) have benefit guidelines, or specific requirements that must be met before coverage for surgery is authorized. We will do our best to help you, but the process can be long and sometimes confusing, requiring a great deal of effort on the part of the patient and our office. In order to begin pre-certification for coverage, our office must receive:
- Psychological Evaluation. Psychological assessment of your state of mind and readiness to have surgery and deal with its aftermath.
- Medical Records. Your history of surgeries, medical conditions, medications and diseases.
- Letter of Medical Necessity. A letter from the patient’s Primary Care Physician documenting that the patient suffers from severe or morbid obesity, has failed multiple different diet and exercise plans, and would benefit significantly from losing a significant amount of weight.
If your insurance carrier does not offer coverage, there are other options. The Roller Weight Loss & Advanced Surgery offers different self-pay and financing options (see below). The insurance code for Lap Gastric Banding is 43770 and the Laparoscopic Roux-en-Y Gastric Bypass is 43644. Co-pay & Co-insurance Out-of-pocket costs to you will vary based on your insurance policy, and we will need to review your policy terms before we estimate the amount you will have to pay. Payment of co-pay and co-insurance is required 10-14 days prior to your scheduled surgery date. Our financial counselor will estimate your co-insurance payment. Payment must be paid in full prior to surgery. Self-pay Patients who elect to self-pay will receive a quote from Roller Weight Loss & Advanced Surgery for the surgery and related costs, based on the procedure that is chosen. Payment is required 10-14 days prior to surgery. Accepted forms of payment include:
- American Express
- Cashier’s Check (no personal checks)
The cost of the operation includes:
- Hospital charges (assuming an average hospital stay without complications)
- Surgeon’s fee
- Surgical assistant’s fee
- Anesthesiologist’s fee
- Pathologist’s fee
- X-Ray charges
This fee only covers routine service related to the surgery and is based on usual and customary charges. The fee estimate will not include:
- Pre-procedure office visits
- Post-procedure office visits
- Diagnostic testing
- Other professional services required as a result of a complication
- Other services provided unrelated to weight loss surgery
Financing If your insurance carrier does not provide coverage for weight loss surgery (bariatric surgery) or provides incomplete coverage, self-paying is an option. However, we understand that some of our patients may need assistance. We offer multiple options for financing, including: