Paying for Surgery

Have you delayed weight loss surgery because you are worried about the cost? The good news is that insurance may cover more than you think. While navigating the world of deductibles and copays can seem complicated, our easy-to-follow steps can be helpful.

Steps for Making Weight Loss Surgery Affordable With—And Without—Insurance

Step 1: Find out if you are covered for weight loss procedures under your insurance policies.

Look for policy information on the insurance company’s website or ask your human resources department for details. Many employers cover weight loss surgery in their insurance plans.

Step 2: Your weight loss surgery program can help with insurance pre-authorization by sending information about your health showing that your surgery is medically necessary.

For example, if you have a condition caused or worsened by obesity, such as diabetes or heart disease, billing codes for those conditions (or others that apply) will be included in the application.

Step 3: Get approval.

Your responsibility will be to understand your insurance benefits, copays and deductible information. Your surgery program can help with the approval process.

Step 4: If you cannot get insurance coverage for your procedure, you still have options.

Many weight loss surgery programs offer a cash pay rate. Financing options, such as a flexible payment plan, can make your procedure affordable.

Many insurance plans do cover bariatric surgery. We encourage you to call to check your benefits. We will also check your insurance information once you send us a copy of your insurance card.

If you have coverage, we will submit a pre-determination letter and documentation to prove you meet medical necessity. Once we submit the letter, it may take a few days to a few weeks to receive a decision.

If your insurance does not cover bariatric surgery, there are some alternatives to consider:

• Does my employer offer more than one insurance plan at open enrollment? If so, does one of the other plans include coverage for bariatric surgery?
• Does the plan that my spouse has include bariatric surgery coverage? If so, can I be added to that plan?
• Do I want to pay for this surgery myself? If this is an option, please call our office at 803-578-8356. We will be happy to discuss specific financial information with you.

Now that you have a good understanding of how to cover the cost of weight loss surgery, why weight?

Weight loss surgery is recommended for individuals with a body mass index (BMI) equal to or greater than 35, regardless of presence, absence, or severity of co-morbidities. Some procedures may be approved for weight loss surgery in people with a BMI of 30 to 35 who have at least one obesity-related condition. Weight loss surgery is considered safe, but like many types of surgery, it does have risks. Consult with your physician about the risks and benefits of weight loss surgery. These testimonials reflect results achieved by these patients. As each case must be independently evaluated and managed, actual weight loss will vary.