Bariatric Surgery Center at Highland Hospital

 

Is Bariatric Surgery Right For You?

Insurers who have approved bariatric surgery at Strong Health The providers listed below have approved weight loss procedures for our patients. Of course, that's no guarantee they will approve your operation, but it tells you who has responded positively to our requests. Aetna Blue Choice Blue Choice Select Blue Choice Option Blue Choice Option & Medicaid Blue Cross Blue Shield Blue Cross Blue Shield-Community Blue Empire Plan/Blue Cross-Metlife Major Medical-NYS Employees GHI GHI Comprehensive Independent Health Tricare Medicare MVP NOVA POMCO Preferred Care Preferred Care Option RMSCO United Healthcare Univera (formerly AHP)

Insurance Coverage

Here's an obvious and important factor to consider when exploring weight loss surgery: Who will pay for the procedure?

In most states, legislation requires insurance companies to provide benefits for weight loss surgery when patients meet the National Institutes of Health (NIH) criteria. But even though insurance coverage is widespread, you should prepare for a lengthy approval process.

Follow the steps below to increase your chances of being approved for coverage.

• Read and understand your insurance company's "certificate of coverage." You can get it from your employer's benefits administrator or your insurance company directly. *
  
  
• Get a referral from your primary care physician if necessary. Even if you don't need one, you must have your doctor's support.
  
  
• Keep accurate, detailed records and save receipts.
  
  
• Document every visit to healthcare professionals for obesity-related issues, including weight loss programs, diet centers, and fitness clubs.

The Insurance Authorization Process

Here's how it works: Your surgeon will send a letter to your primary care physician asking your doctor to write a letter to establish the "medical necessity" of weight loss surgery by proving:

• You are morbidly obese and have a BMI of 40 or higher
  
  
• You have been obese for the past five years or longer
  
  
• You have attempted, under your physician's care, other methods of weight loss for at least two years. These may include: Behavior Modification, Optifast, Medifast, Drug Therapy, Overeaters Anonymous and diet centers.
  
  
• You have co-morbidities (if you have any)—such as hypertension, diabetes, sleep apnea, degenerative arthritis, heart disease—that merit consideration of medical necessity for surgery.

The letter should also mention:

• If you have any significant liver, kidney, or gastrointestinal disease.
• Whether you have a history of alcohol or substance abuse.
• That a thyroid test has been ordered and results will be sent to your surgeon.

Don't Give Up: The Appeals Process

Even if your insurance company denies the pre-authorization, you still have an opportunity to appeal. So reply quickly.

Disability Guidelines

Please bring us your disability form from work. Complete your portion, sign and give it to us with a stamped, addressed envelope or fax number. More information about disability guidelines

* The only time any insurance has not covered the surgery (when a patient meets criteria) is when there is a specific exclusion of benefits for treatment of morbid obesity.