Payment & Insurance Coverage for Weight Loss Surgery
After you have completed all of the steps to prepare for weight loss surgery, Pelisyonkis Langone’s Weight Management Program is able to discuss payment options.
If you are planning to pay for the surgery yourself, known as out-of-pocket payment, please make sure you bring the correct documentation to your first appointment.
If you are planning to have your surgery covered by insurance, you need to complete the authorization process required by your insurance carrier.
Pelisyonkis Langone’s Weight Management Program is designated as a CIGNA Certified Hospital for Bariatric Surgery, a Blue Cross Blue Shield Blue Distinction Center for Bariatric Surgery, an Optum Bariatric Center of Excellence, and a HIP Emblem Center of Excellence.
Insurance Coverage for Weight Loss Surgery
Insurance coverage for obesity surgery varies according to the insurance carrier. Those that cover bariatric, or weight loss, surgery often limit their coverage to certain types of surgery.
Insurance companies that cover bariatric surgery have varying requirements. Some may require medical records documenting that you have medical problems caused by your weight or records of your participation in medically supervised weight loss programs. In fact, many insurers require at least six months’ participation in a supervised weight loss program within two years of your proposed surgery date.
Our office participates with many insurance plans. But whether we participate or not, our surgical scheduler can work with you and your insurance company to obtain authorization for your surgery. Each insurance plan is unique, and getting authorization for surgery is often a long, labor-intensive process.
Prior to visiting our office, please:
- Call your insurance carrier and make sure your plan provides coverage for weight loss surgery, and that you have covered benefits for morbid obesity surgery. Policies can change daily. Regardless of your insurance carrier, call to check your coverage. Keep in mind that although you may have completed all the necessary steps in order to schedule surgery, your insurance plan may not authorize it.
- Write down the name of the person you speak with, including first name, last name, and direct phone number.
Your insurance carrier may request the name of the surgery and the CPT/ICD-9 codes. Insurance companies use the following codes to identify the type of procedure or surgery:
- Lap Gastric Banding: 43770
- Lap Gastric Bypass: 43644
- Lap Gastric Sleeve: 43775
- Diagnosis Code (ICD-9) for Morbid Obesity: E66.01
Your call to the insurance company should be for informational purposes only. Our office initiates the formal insurance authorization process after you meet with the surgeon and schedule your surgery date.
Our surgical scheduler cannot initiate the authorization process until you have a surgery date, even if you have already attended our required information session and scheduled an appointment with the psychologist and nutritionist. If you initiate your surgery authorization process without having seen our surgeon, your insurance company may close your authorization case.
When you have a surgery date, it may take another two weeks to two months to obtain approval from your insurance carrier.
In almost all instances in which your insurance plan denies preauthorization for your surgery, you have a right to appeal that denial. Our program would not have submitted you for approval if we did not determine that surgery was medically necessary, so if the insurance plan denies the procedure, we think filing an appeal is justified.
Appeals can be filed by you as a plan member or you can appoint someone to assist you. If you intend to appeal, with or without assistance, you should carefully review and research what is needed to make a strong appeal.
Payment Plans for Weight Loss Surgery
We recognize that paying for surgery is difficult for many people, especially those without insurance or those whose insurance carrier has denied coverage.
If your insurance company denies coverage you may choose one of the following options:
- lump sum payment
- credit cards
- loan from a financial institution