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Paying for Surgery

Many insurance companies as well as Medicaid and Medicare, now recognize obesity as a substantial health risk and are paying for bariatric surgery. Our Financial Counselor will work with you and your insurance company to determine your eligibility for approval of weight loss surgery.

If you aren’t covered or are uninsured, we can assist you in finding alternative financing options to pay for your care.

Some of the common questions we hear are:

Will my insurance cover bariatric surgery?

Some insurance carriers do not provide coverage for bariatric surgery. You must call your carrier directly to verify coverage and benefits. Ask specifically if surgical treatment of “morbid obesity” is covered.

If your insurance carrier does cover bariatric surgery, you will need to go through the approval process, which involves meeting specific requirements. If you are denied, meet the requirements and try again. If you have an exclusion on your policy for weight loss surgery, it will not be possible to get an approval.

What are the insurance company requirements?

 Please note: You MUST call your carrier directly to verify coverage and benefits. The information below is only for reference and may change without notice. 

Aetna

BMI >40 with secondary health condition or >35 with primary health condition (Coronary Heart Disease, Type 2 Diabetes Mellitus, Obstructive Sleep Apnea, Hypertension). Participation in physician or dietitian supervised nutrition and exercise program of at least 3 to 6 months duration within the past 2 years. Patient can not gain weight during the program.

BCBS

Anthem – BMI>40 or BMI>35 with health condition.  6 month medically supervised weight loss program, psychological evaluation and medical clearance.
BCBS of Illinois – BMI>40 or BMI>35 with health condition.  Documentation of a 3 month physician supervised diet, psychological evaluation, medical clearance
BCBS of Michigan – BMI>40 or BMI>35 with health condition.  Documentation of a 6 month consecutive physician supervised diet, psychological evaluation, medical clearance
BCBS of Minnesota – BMI>40 or BMI>35 with health condition. 6 month medically supervised weight loss program, psychological evaluation, medical clearance, 3 years of weight history
Highmark BCBS – BMI>40 or BMI>35 with health condition.  Documentation of a 3 month physician supervised diet, psychological evaluation, medical clearance

Cigna

BMI >40  and secondary health condition or >35 with primary health condition (Coronary Heart Disease, Type 2 Diabetes Mellitus, Obstructive Sleep Apnea, Hypertension). Failure of medical management including evidence of active participation within the last two years in a weight-management program that is supervised either by a physician or a registered dietician for a minimum of three months without significant gaps. A program such as Weight Watchers, or weight loss medication alone is not considered sufficient documentation.  A psychological evaluation is also required.

Whirlpool

12 month medically supervised weight loss program, psychological evaluation within 90 days of surgery, and medical clearance.  Has a maximum amount of $75,000 that the plan will pay for surgery.  Only one surgery per lifetime.

Buckeye Community Health

Must have a referral from primary care physician to schedule an appointment.  6 month medically supervised weight loss program, psychological evaluation, medical clearance, cardiology clearance, and pulmonary clearance. 

Caresource

Must have a referral from primary care physician to schedule an appointment.  9 month medically supervised weight loss program, psychological evaluation, medical clearance from primary care doctor.

Medical Mutual of Ohio

BMI must be > 40 or >35 with qualifying co-morbidities for the past year.  Psychological evaluation by a mental health professional.  Medical clearance by a MD or DO.  3 month medically supervised weight loss program.

Paramount

BMI must be > 40 or >35 with qualifying co-morbidities.  Preoperative medical evaluation.  Psychological Evaluation.  Medically supervised weight loss program for 3 months.

Paramount Advantage

Have to have referral from primary care physician to schedule consultation appointment.  BMI must be > 40 or >35 with qualifying co-morbidities.  Preoperative medical evaluation.  Psychological Evaluation.  Medically supervised weight loss program for 3 months.

Tricare

BMI>40 or BMI>35 with health condition.  6 month medically supervised weight loss program, psychological evaluation, medical clearance from primary care doctor.

United Health Care

BMI > 40 or > 35 with qualifying comorbidities.  Physician supervised 6-month weight loss diet program, psychological evaluation, medical clearance from primary care doctor.

 

Most insurance companies adhere to national guidelines regarding requirements for weight loss surgery. In addition, many also require that you participate in a physician supervised weight management program.

Does the program accept Medicare?

The Center for Weight Loss Surgery accepts Medicare eligible patients whose bariatric surgery must be performed at a Center of Excellence.

Does the program accept Medicaid?

Yes, but a referral from a primary care physician is necessary before you can schedule a consultation with the CWLS. Their requirements are very similar to commercial insurers.

Does the program offer self-pay or financing options?

For those patients who are uninsured or do not have weight loss surgery benefits with their current insurance plan, we offer a variety of financing options. Our surgery coordinator will help you navigate the options upon request.

How long does it take to pre-authorize my surgery?

Each insurance company has its own set of rules regarding surgical pre-authorization. This can take two weeks to a month.

Questions?

If you have questions about our payment options, call us at 877-705-2957, option #4. Our hours are  Monday through Friday 8:30 a.m. to 4:30 p.m.