If you are interested in learning more about our program, register today
for a free information session. Our office will contact your insurance
provider to determine if you have coverage*. We STRONGLY encourage you
to also contact your insurance company and/or employer's human resources
department to get this information as well as a copy of your policy. Please
be aware that regardless of your policy, you will be responsible for all
non-covered services.
As you are speaking with the insurance representative, be sure you make note of:
The name of the representative you spoke with
The time and date you spoke to the representative
Their responses to your questions
Questions to ask your insurance company that may assist you in this process:
Is bariatric surgery a covered benefit under my plan?
Is medical weight management covered under my plan?
Is Laparoscopic Roux-en-Y Gastric Bypass (CPT code 43644) a covered benefit
under my policy?
Is the Laparoscopic Gastric Sleeve (CPT code 43775) a covered benefit under
my policy?
Is the Laparoscopic Duodenal Switch (CPT code 43659) a covered benefit
under my policy?
Is Laparoscopic Adjustable Band (CPT code 43770) a covered benefit under
my policy?
Is revision bariatric surgery a covered benefit under my policy?
Are the Metabolic & Bariatric Program providers IN-NETWORK or OUT-OF-NETWORK?
If OUT-OF-NETWORK, am I still covered and what is my financial responsibility?
What percentage of the surgery is covered by my plan?
What is my yearly deductible? Have I met it?
If I haven't met my deductible, how much more do I have to pay out of pocket
before I meet it?
What is my maximum out of pocket expense?
What is my specialist co-pay?
Is a referral required?
Are there special requirements, such as a physician-supervised diet, mental
health evaluation, weight history, etc. that must be completed before
insurance will authorize my surgery?
If yes, document the requirements so we can help you meet them.
You are financially responsible for any deductibles, co-payments and/or
non-covered services as required by your insurance provider. Predetermination
does not guarantee authorization or payment of surgery and is subject
to exclusions and limitations.
Insurance and Financing FAQ
Which insurance providers consider the Metabolic & Bariatric Program
as IN-NETWORK?
We are considered IN-NETWORK with the following providers, however you
are encouraged to call your insurance provider and verify if your specific
policy covers bariatric surgery. If your insurance is not listed below
please contact the office to discuss your specific carrier with an insurance
specialist.
Aetna
Anthem Health Keepers HMO, Medicaid
Blue Cross Blue Shield
Cigna Coventry/Southern Health
Medicaid
Medicare
Mamsi
Optima Health HealthSmart
Unicare/Healthlink/NCPPO
United Healthcare
4Most
What if my insurance will not cover the program?
We have self-pay packages available. Please contact our office for more
information. In addition, we recommend that you contact your employer's
human resources department. You can provide them with the medical conditions
caused by obesity, the monthly cost associated with the medication required
to treat the conditions and the amount of time off work needed to attend
physician office visits to care for the conditions. This information will
help your employer understand the benefits of covering surgery for future
insurance policies, but may not affect your current policy.
Are finance options available to help me with my medical expenses?
We accept Care Credit, which offers financing for medical purposes only.
This can help you with cost of office visits, surgery, vitamins, supplements, etc.
