Will Insurance Cover my Weight Loss Surgery?

The Role of a Patient Advocate

Will my insurance pay for my surgery?

What insurances does Texas Bariatric Specialists accept?

Insurance coverage and the cost of weight loss surgery are perhaps one of the greatest concerns for patients who consider surgical weight loss. The questions most patients ask are;

  1. Will my insurance cover it?
  2. And if not, how much is my procedure going to cost?

Texas Bariatric Specialists have a long standing belief that first and foremost a patient should consider the benefits of surgery, and then identify the procedure which will best serve them, prior to even worrying about insurance and cost. Mental and physical preparation for surgery should be the first and foremost consideration when evaluating surgical options. With that being said, money and financing cannot be overlooked. Through our “all-in-one” approach, Texas Bariatric Specialists significantly streamlines this entire process into one productive day.

  1. Upon registering for your new patient seminar/clinic you will be asked for your insurance information.
  2. At your one-on-one consultation with Dr. Patel he will review whether or not you have the benefit of weight loss surgery, what your benefit plan requires you to do to prove medical necessity, and what your out-of-pocket expense will be if you pursue surgery. Very few if any surgeons take the time to review this valuable information with you and at the end of the consultation Dr. Patel even gives you a projected surgery day/month.
  3. Dealing with an exclusion in your insurance regarding weight loss surgery;
  1. Many patients consider visiting the surgeon a total waste of time if they have an exclusion within their insurance, or when surgery is not an option. Nothing is further from the truth, if one considers the value of visiting with a weight loss surgeon who offers medical and surgical weight loss surgery options, and for evaluations by a nutritionist who can improve your behavior related to eating, and potentially have you lose a modest amount of weight. The benefits should not be under spoken. There are other options out there other than weight loss surgery including medical weight loss. Additionally things in the insurance environment and with your employer’s policies change constantly and Dr. Patel can advise you of what changes one needs to look for, and other changes that you may be able to make in regards to coverage. One should never consider it a waste of time to visit with the surgeon and to be initiated into a program for your overall well-being even if the insurance company says no.
  • You will then be assigned a unique username and password which will allow you to access our database online from any computer in the world in order to evaluate where you are in your insurance authorization process. This is unique to any program in South Texas, where you can have a moment-by-moment update in regards to your progress through a tedious insurance verification process and authorization process. Through this matrix, the computer will demonstrate what tests that are still pending, what tests have been completed, and the number of months remaining in your pre-previous predetermined weight loss program.
  • Once you have met with Dr. Patel you will be assigned to an Insurance Advocate. The assignment of advocate is based upon your insurance and the timeline which you are going to be able to achieve surgery and where you are going to pursue your physician supervised program.
  • Physician Supervised Diet Programs- Many insurance programs can require a 3 to 12 month weight loss process prior to weight loss surgery. As part of this process a member of our staff will contact each patient at least once a month personally or via email.
  • Based on the discussions that you have had with Dr. Patel regarding your weight loss surgery insurance benefit and your out-of-pocket expenses, and a timeline within which your surgery should be able to be approved are not being met by your standards, you are encouraged to email Dr. Patel by using this form. This individualized attention given by Dr. Patel is a hallmark of his practice from the time of its initiation and now even with hundreds of patients in the pipeline. He offers this unique one-on-one level of access and you are highly encouraged to stay in touch with him at any point your case is not being addressed to your satisfaction.

The Insurance process for your weight loss surgery can be a very stressful process. Our center designates a Patient Advocate to each of our patients. This person will do the following:

  • Call your insurance company for you and verify if your company offers the benefit.
  • Walks you ‘step-by-step through all the things that the insurance company will require you to do if coverage is available.
  • Assist in financing options if insurance coverage is not available.

Will my insurance pay for my surgery?

Many insurers will cover your weight loss surgery, however it is difficult to achieve insurance authorization on your own. This is why we assign each patient a personal authorization specialist to stream-line this process. Insurance coverage varies from patient to patient and employer to employer. This is why it is important to work with a specialist.

What insurances does Texas Bariatric Specialists accept?

We accept all private insurances. Both ‘in-network’ and ‘out-of-network’ insurance plans are accepted. Please call us for details as all provider lists are not always complete or up to date. We unfortunately do NOT accept Medicaid at this time.

 

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