Weight Loss Surgery, Gastric Bypass

General Information: We work with all of our patients to help them obtain insurance approval if there is potential coverage. This process begins with your first visit to our office for consultation. Our insurance coordinator will call your insurance company to ask about coverage for weight loss surgery. If you do not have coverage, our coordinator can discuss financing options with you if you wish. Based on the days visit, we will submit a comprehensive medical package of information to your insurance company for authorization to proceed with weight loss operation of your choice. It is important to recognize that many commercial insurance companies may list weight loss surgery as excluded benefit. Some insurance policy may cover the "medically necessary" weight loss surgery if employer is paying for supplemental obesity surgery "rider" to provide this benefit to their employees. In all instances, insurance companies make their own rules as to what is considered medically necessary.

Typical requirements to establish "Medical necessity" are that individual seeking weight loss surgery:

  • Has a Body Mass Index (BMI) of over 40, or
  • Has a Body Mass Index (BMI) of over 35 and are experiencing one or more co-morbidities. Commonly accepted co-morbidities are:
      High blood pressure/Heart disease
      High blood cholesterol
      Sleep apnea/respiratory problems
      Gastro-esophageal reflux/Heartburn
      Osteoarthritis of weight-bearing joints
      Gallbladder disease
      Menstrual irregularities
      Infertility/Pregnancy complications
        Urinary stress incontinence
  • Has tried medically supervised diet for at least 6 months in the proceeding 2 years without successful outcome. Most insurance company will insist upon documents from the physician who supervised this dietary regiment with monthly weight and effort documentation. If you have not done this, we encourage you to get started on this requirement as soon as possible.

Medicare / Medicaid: We are designated as Bariatric Center of Excellence as such provide care for Medicare and Medicaid patients. Please note that both of these agencies have published strict criteria in regards to qualified candidates for weight loss surgery. We strictly adhere to these policies and will not deviate from their requirements.

HMO: If you have an HMO insurance policy, you must verify that our office visit has been authorized by your insurance prior to your first appointment. If there is no authorization on file with your insurance for the initial consultation, your appointment may be cancelled. If you wish to proceed with consultation, you may be financially responsible for the services you receive. Our office will only call to verify that you have the weight loss benefit available under your policy on the day of your first appointment.