Getting Started

How to get started

The process leading up to bariatric surgery varies depending on each person’s medical history and insurance requirements. Please review the process below for additional information.

Appointment Scheduling

To get started with our program, you will need a referral from your primary provider or you can call to schedule an appointment.

Evaluation

During the surgical weight loss evaluation process, you will meet with a nurse, dietitian, surgeon and insurance specialist. You’ll also have a one-on-one meeting with an advanced practice provider for an initial history and physical. After that visit, you will be scheduled for:

  • A nutrition assessment.
  • A psychological evaluation.
  • A weight management program (if your health insurance requires this).
  • Additional medical tests, as determined by the surgeon.
  • Your medical record will be reviewed. After all your tests are completed you will learn whether the clinic’s surgeon/physician assistant has cleared you for surgery.
  • Your case is sent to your insurance carrier for approval.
  • After the insurance company approves the surgery, your pre-operative appointments and surgery will be scheduled.

Insurance & Financing

By using the Insurance Review Form in the Patient Profile Packet, you will know if your policy has benefits for weight loss surgery. If it does and you want to proceed, send in your Patient Profile Packet and the Insurance Review Form. We will screen your health history to make sure you are an appropriate candidate and our Insurance Team will make sure you meet the criteria set forth by your insurance policy. Assuming you meet all criteria, we will call to schedule your first appointment, where you will receive a personalized benefits form that will estimate, to the best of our abilities, your total out-of-pocket expenses.

Insurance FAQs

Most insurance plans require that your BMI be 35 or higher.

Does my insurance have benefits for weight loss surgery?

For commercial insurance policies, contact the customer service number on the back of your insurance card and ask this question exactly: “In my certificate of coverage are there benefits for weight loss surgery for morbid obesity if medically necessary?”

For Medicare and Medicaid, there are benefits for weight loss surgery as long as the criteria is met. There is no need to contact Medicare and Medicaid.

If I meet the co-morbid and BMI requirements, do I still have to do a medical weight management program?

Most insurance companies that require medical weight management still require it no matter how many co-morbid diagnoses you have.

If my doctor writes a letter saying I really need the surgery, do I still have to do a medical weight management program?

Yes, medical weight management is part of criteria set by your insurance company. Your physician can write you a letter of support which will assist in obtaining approval, but you still have to complete the program.

My co-worker/friend started the same time I did. Why are they moving through the process faster than me?

This is a question that is asked a lot. Sometimes additional testing is required, one primary care may get the documentation back faster, or if your friend has a different insurance than you, maybe you were required to do a medical weight management program and your friend was not. If the insurances are different, then it may be because one insurance just takes longer to process than the other.

My insurance says I need to complete a medical weight management program. What does that mean?

Usually a medical weight management program must be for at least 6 full months, which is one initial visit and 6 follow-up visits. Your appointments must be consecutive and the program must be successful, meaning your end weight must be the same or less than your start weight.

What if my insurance says there is an exclusion in my policy?

This means that your particular plan does not have benefits for weight loss surgery, no matter if you meet the medical necessity requirements or not. Your insurance may tell you that you have appeal rights. Keep in mind that you will be appealing policy and not medical necessity. If there are no benefits for weight loss surgery, it basically means that the benefit was not purchased by your company.

If my insurance will not pay for the surgery, can I pay for the surgery myself?

We do offer bariatric surgery for patients who would like to pay out-of-pocket. Please contact us directly for a quote.

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Please call us at 906.449.1460.