Insurance Info

Insurance Verification :: Submission Requirements
Appeals and Patient Financing :: Insurance Carriers

Insurance Verification

To determine if your insurance policy covers obesity (or “bariatric”) surgery, refer to the policy package that all insured people receive after they have paid their first premium, or if they have chosen a plan offered by their employer. Typically, there are two sections that describe the extent and limits of coverage. The first is usually called "What Is Covered" or "Covered Expenses." These are the healthcare benefits for which the company will pay. The other section is "What Is Not Covered" or "When the Plan Does Not Pay Benefits." In this section the company tells the insured which treatments they have to pay for themselves. You should refer to your insurance information to determine whether your policy covers surgical therapy for the treatment of morbid obesity.

Some policies will outright exclude bariatric surgeries. Others may have certain parameters around which bariatric procedures they cover and how much of the costs they cover.

Submission Requirements

A Letter of Medical Necessity and weight-loss history are necessary to obtain prior authorization for obesity surgery. A Letter of Medical Necessity states why significant weight loss is medically necessary for a patient and usually includes the following information:

  • Patient’s weight (which should be 100 pounds or more above ideal weight or a BMI more than 40 or more than 35 with associated medical problems to qualify)
  • List of medical problems associated with obesity, such as type 2 diabetes, sleep apnea, hypertension, etc.
  • Number of years patient has been overweight (which should be at least five or more)
  • Number and types of failed weight-loss programs attempted in the past

If you create a document or packet listing all your weight-loss attempts (self-controlled or medically supervised) and their results, you can substantially increase your chances of getting insurance coverage for the LAP-BAND procedure. You should include any commercial diets or medical records of your weight-loss efforts.

Appeals and Patient Financing

If coverage has been denied upon the initial prior authorization request, you can appeal by addressing the specific reasons why your request has been denied.

When insurance reimbursement is not available, patient financing is another alternative you may consider. Please ask us about available patient financing programs during the patient seminar or your office visit.

Insurance Carriers

The insurance carriers listed below have been known to cover Weight Loss Surgery. However, this is not a guarantee, please contact our office to verify.

Name
Aetna – QPOs
Aetna US HealthCare
Atena/US Health Care – Federal
BC/BS
Blue Cross
Blue Cross – PPO
Blue Cross Blue Shield – HMO
blue cross, healthchoice – PPO
Blue Cross/Blue Sheild
Cigna
Cigna first… then United HealthCare – HMO
Cigna HealthCare HMO – HMO
Empire – HMO
EMPIRE (GOVT) PLAN
Empire B/C B/S – PPO
Empire Blue Choice
Empire Blue Cross
Empire Blue Cross Blue Shield – PPO
Empire Blue Cross Blue Shield
Empire Blue NY – PPO
Empire Government
Empire Healthchoice
Empire Plan – United Health Care
ghi – PPO
Ghi – B.C/B.S
GHI – City Of New York
HIP – Prime
HIP – Prime
HIP Heritage
HIP VIP through Medicare
MAGNACARE LOCAL804 – PPO
MDN
MDNY – HMO
MDNY
MEDICAID
Medicaid – Medicare
NANCY – 1199
Oxford
Oxford
Oxford – Freedom
Oxford – Freedom Select Pro
Oxford – Freedom
Oxford
Oxford Freedom Plan Select
United Health Care – PPO
United Health Care – PPO
United Health Care HMO/Medicaid
United HealthCare
United HealthCare – PPO
United HealthCare – EPO
United HealthCare – EPO
United HealthCare
United HealthCare – Choice Plus
US HealthCare – HMO
Vytra