Insurance coverage is an important aspect of your weight loss surgery journey. Every health plan is different in its coverage and requirements for surgery. Our office is here to help you determine your coverage. We will do an insurance verification for you at our informational seminar.
Since we are a Bariatric Center of Excellence, we accept most insurance plans. Some insurance plans require a hospital to be a BSCOE or they will not cover the benefits for the surgery. Now patients with Medicare, Medicaid, UPMC Health Plan, and many other insurance plans can have their surgery at Windber Medical Center by Dr. Kim R. Marley.
The road to having weight loss surgery can be long and often frustrating. If you are considering surgery, there are some things you can do to make that process a bit easier.
The first thing that you should understand is that most, if not all insurance plans, require documentation of non-surgical, medically or professionally supervised weight loss attempts before allowing access to surgery. This is frustrating for someone who has experienced difficulty losing weight and keeping it off. It’s hard to understand why “yet another diet” is needed. An even more frustrating thing is when the insurance company asks you to “prove” those efforts. Sometimes proof can be hard to come by, especially since most attempts are not well documented.
People often ask how long such a program can or should last. From the insurance approval perspective only, many insurers are looking for 6 consecutive months of documentation that includes monthly weigh-ins and counseling on the plan signed by the physician. Highmark, Cigna, Aetna and UPMC are examples of insurance companies that require this.
Ways to document your weight loss efforts include copies of your medical record. You should be sure to have your doctor put on your medical chart that he/she is working with you on weight loss and supervising your efforts. We have forms available in our office that can be filled out by your physician and will generally meet the criteria for a “weight loss visit”. You can also do your supervised weight loss visits through our office.
Other documentation of past weight loss attempts could be computer printouts from the pharmacy for medications such as Meridia, Phentermine, Xenical, Phen-Fen or Redux. As well as receipts for any over the counter weight loss medication you may have taken in the past. If you’re involved with a commercial plan like Weight Watchers, Jenny Craig or similar programs, you can get letters or receipts for documentation. These will sometimes be accepted by insurance plans.
Our office will coordinate any other documentation your insurance company requires prior to authorizing surgery. We will walk you through each step of the process and put your “package” together to submit to your insurance plan for authorization.