Insurance FAQs
For many patients, some of the most important and sometimes frustrating questions about surgical weight loss concern insurance and costs.
To help ease your mind, our financial team has created a list of frequently asked insurance and payment questions.
Will My Insurance Pay for Bariatric Surgery?
Because there are many different insurance carriers, each patient’s coverage will depend on the exact criteria that are mandated by their insurance company/employer. A patient may have to meet certain guidelines such as a medically supervised weight loss trial which can last in duration from 3-12 months. In addition, a minimum body mass index (BMI) of 35 with co-morbidities (diabetes, hypertension, sleep apnea, etc.) or a BMI of 40 or greater with no co-morbidities is required to proceed with surgery.
Does Medicare Cover Bariatric Surgery?
In some cases, Medicare will cover bariatric surgery. However, to qualify for coverage, you will need to participate in a supervised weight loss trial for 18 months before surgery can be considered.
What is a Supervised Weight Loss Trial?
A supervised weight loss trial, which is used to help document that you are unable to lose weight without the help of surgery, can last anywhere from three to 18months. This trial requires seeing your primary care physician or our bariatrician once a month for the time indicated by your policy. All policies require the supervised weight loss visits to be consecutive.
What Does My Insurance Company Need to Cover My Surgery?
The following four points must be documented on each of your visits:
- Office Note – Your insurance company will require a note from your physician’s office that includes your height, weight, and body mass index. The number of pounds lost or gained should be noted. A comment should be included if there is failure to lose weight or a weight gain is recorded.
- Low-Calorie Diet – There must be documentation of a low-calorie diet with the number of calories listed on the office encounter form (ex. 1,000-1,200 calories per day).
- Exercise – The type and duration of exercise the patient is attempting must be recorded (ex., Walking 30 minutes per day; swimming 10 laps in pool; stretching for 20 minutes if patient is wheelchair bound, etc).
- Behavior Modification – Behavior modification must be attempted and documented (ex., Parking further away from store; putting fork down between bites, chewing each bite 20 times before swallowing; using stairs instead of elevator; walking instead of taking the shuttle bus, etc).
Do I Need a Referral from My Primary Care Physician?
Yes. All patients will need a referral from a physician, and your primary care physician does play a key role in determining if you are eligible for surgery. Once he/she determines you are a potential candidate for surgery, a referral needs to be sent to our office via fax at 850-416-4865.
How Long Will It Take to Get Authorization from My Insurance Company?
The length of time it takes to process an insurance authorization varies from patient to patient. Although the process from initial consult to surgery may seem lengthy due to insurance criteria, we recognize the end result will mean a safe, healthy, and satisfied outcome for our patients. We are dedicated to being there for all of our patients and work closely with each individual to provide a clear outline of the specific requirements needed for approval from insurance.
What If My Insurance Will Not Pay or I Don’t Have Insurance Coverage?
For patients who wish to proceed with surgery and either their insurance does not cover it or they have no insurance, funding options are available. Please call us at 850-416-SLIM (7546) to discuss various lending sources.
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