Insurance and Financing
Over the last few years, more and more insurance companies are covering bariatric surgery for the treatment of morbid obesity. This is due to the realization that morbid obesity is a disease for which conventional weight loss methods can be ineffective. Weight loss surgery has been shown to be effective in alleviating co-morbidities such as hypertension, type II diabetes (adult onset), sleep apnea, high cholesterol/lipids, polycystic ovary syndrome, respiratory compromise, and cardiac disease. Although the National Institute of Health endorsed bariatric surgery for the treatment of morbid obesity in 1991 with a set of criteria, most insurance companies have their own set of criteria that must be met in order for the surgery to be deemed “medically necessary.”
Gayla Ellison is the Insurance Coordinator for our bariatric center and she will guide you through the process steps to surgery. To contact Gayla: gayla.ellison@lpnt.net or Phone: 606.802.2865
We participate with all insurance including Medicaid
Criteria Most Insurance Companies Require
1. A body mass index (BMI) of greater than 40, or between 35 and 40 with life threatening co-morbidities, or 100 pounds or more over the ideal body weight.
2. Medically supervised weight loss history records for the past year (actual records/notes from the physician). Some may require six-seven consecutive months of at least one medically supervised weight loss program with your primary physician, within the last two years. Your insurance company may require monthly weigh-ins during that six-month period as well.
3. A letter from the primary care physician including a strong statement recommending surgery as the last resort for the patient to treat their medical conditions because all other weight loss efforts have failed.
4. A psychological clearance from a psychiatrist or psychologist.
5. Recent photographs with a front, side and back shot in the same outfit.
6. A nutritional assessment with a bariatric dietician
Your insurance company may request any of the above mentioned criteria, or additional criteria. Although the letter sent to the insurance companies generally establishes medical necessity, surgery is still considered an elective procedure. Some insurance companies do not cover the surgery regardless of any documentation of the above mentioned facts. The best way to determine if your insurance company will pay for bariatric surgery is to check your benefits booklet. If you cannot locate your booklet, or do not have one, you may contact your insurance company by phone. A representative would be able to help you with this.
The bariatric insurance process can be a very labor intensive process. Patients may become frustrated due to the waiting time involved. Please be assured that we process each patient packet as it is recieved and in a timely manner.
The following is an approximate wait time for the bariatric insurance approval process:
- Patient packet received until first appoinment day (consult day)- three weeks
- Consult day until insurance approval- varies widely by insurance but can be anywhere from five days to six weeks (excludes those patients who are required to complete a time specific physician supervised diet)
- Insurance approval until second appointment day (pre-op day)- two weeks
- Pre-op day until surgery day- 1-3 days
Please remember our insurance specialist spends most of the day on the phone to insurance customer service representatives. Calls coming into the office for the insurance coordinator to update you on your process status may delay the staff in getting insurance approvals. When possible to do so, please consider emailing your questions or concerns to the staff instead of phoning. This helps to keep the phone lines free for insurance approvals. We have found that the patient receives a timelier response to their concerns this way.
