Weight Loss Surgery Payment Frequently Asked Questions
What Are My Payment Options?
For many people, weight loss surgery is affordable because it is covered by their health insurance plan. People who do not have insurance coverage for lap band and other surgeries must pay for it on their own.
This is called self-pay or cash-pay. Some patients pay for their own surgery and consider it a critical investment in their health.
Whether you have health insurance or opt for self-pay, you will need to prepare detailed written documentation. From diet history to co-morbid conditions, this information will come in handy.
How Do I Work with My Insurance?
Many people find dealing with health insurance companies to be intimidating and are not sure how to even get started. If your bariatric surgeon recommends surgery, consider the following:
- Your best resource for how to deal with your health insurance company may be your weight loss program. The Davis Clinic has weight loss coordinators who work on your behalf with your health insurance company. Our insurance specialists have expertise with bariatric insurance verification, pre-certification and approvals.
- Read your Certificate of Coverage (COC). A COC describes your insurance policy in detail, including what it covers and what it excludes.
- Write down your weight loss history. Go as far back as you can and include diets and exercise programs. If possible, pull together receipts for gym memberships and weight loss programs.
Quick Fact: Writing a Weight Loss History
Write a description of how morbid obesity decreases the quality of your life. Be sure to include details such as difficulty walking, socializing, or maintaining personal hygiene. This documentation can be useful for your weight loss surgery program and health insurance company.
We verify your insurance at no cost.
Our program offers FREE, no-obligation insurance verification. We will contact your insurance provider and determine whether your plan includes coverage for weight loss surgery. Simply provide us with information about your health and insurance plan and we'll do the rest.
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We are contracted with the following insurance providers:
- Aetna HMO, PPO, POS, EPO
- Blue Cross Blue Shield of Texas PPO, POS
- ChampVA -Tricare Standard (as secondary)
- Galaxy Health Network
- HealthSmart PPO
- Humana Choicecare PPO
- Medicare – Traditional (contracted for Medicare Texas patients only)
- Memorial Hermann Healthnet Providers
- Pacificare PPO
- Texas Municipal League
- Texas True Choicev
- Unicare HMO, PPO
- United Healthcare
If you have an exclusion on your health insurance policy, we will be happy to speak with you in our office during your consultation about the options available to you if you decide to pay out of pocket. Costs vary based on procedure and hospital location.
How Do I Appeal a Denial?
If the insurance company turns down your request for lap band or other weight loss surgery, you may be able to appeal the decision. Many people do not take advantage of the appeals process or know of the laws that govern insurance companies in their state.
Work with Your Weight Loss Surgery Program
Assistance is key. It is critical that you work with your bariatric program to determine the correct approach to appealing a denial. We are there to assist you and to help you adhere to your policy's requirements.
Possible Options After Appeals
Even if you exhaust the appeals options, you still may have options:
- Independent review board: This is an option available to people in more than 40 states and doesn't require a lawyer. Judgments usually are issued in 60 days. Check your state's website for specific filing instructions.
- Arbitration: Some health insurance companies require patients to use a third party—other than the patient's lawyer and the insurance company instead of going to court.
- Litigation: This option is expensive and takes a lot of time.
Ready to Get Started?
Our NewStart program is designed to ensure that when the day of your surgery arrives, you'll be ready and in the best possible condition for a fast, healthy recovery.
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