Insurance:
While the
LAP-BAND® System procedure is increasingly covered by insurance policies
due to a growing recognition by the healthcare industry of the high costs associated
with obesity and obesity-related health problems, navigating the insurance process
can sometimes be overwhelming.
That is why at Wisconsin Bariatric we have special staffs dedicated to help you
through insurance approval process and understand all of your available options.
There were some basic steps you should understand before you approach the insurance
company with a request for any weight loss surgery. The more information you can provide
up front, the faster your request will be processed towards a satisfactory end
result.
1. Write down your Height, Weight,
BMI , and have any diet history and obesity related
Medical problems you may have ready.
2. Call the Customer or Member Services line listed on your insurance card and ask
the following question:
- Is weight loss/obesity surgery (or "bariatric surgery") a covered benefit?”
- If the answer is "yes", then: Is the Lap-Band (or Adjustable Gastric Banding) procedure
covered?
If the answer is “Yes”, and you have:
- PPO Coverage, or HMO Coverage,
- Obtain a Referral from your Primary Care Physician ("PCP") before making a Lap-Band
consultation appointment at Wisconsin Bariatric.
- Receive a "Physician Evaluation" by our surgeon during your initial consultation
visit.
-
Then our clinical assistant will coordinate with your insurance company to determine
which specific procedures are a covered benefit. Generally, insurance only covers Bariatric
procedures (including Adjustable Gastric Banding) when it is medically necessary.
-
Our surgeon will also write the pre-operative evaluation. It may include nutrition
consultation, psychiatric consultation, lab tests, pulmonary tests, and x-rays.
(Again, please consult with your insurance company to determine whether these tests
will be covered.) You may need another referral for these tests from your PCP in
order for your insurance to cover the costs of the tests.
-
Once we have all the necessary information required by your insurance company, we
will work with the nurse reviewer assigned by your insurance company and we will
submit all of the documentation that they require from us to review the medical
necessity for the surgery.
-
It generally takes 4 to 6 weeks for an insurance company to approve or deny a request
for pre-authorization.
-
While you are waiting for a response, we recommend you call the Member Services
number on your insurance card to follow-up. When you call, indicate that you are
checking on the status of your "Pre-Authorization Request." They will need your
member ID number listed on your card to access the information on the status of
your request.
-
Once we obtained the pre-authorization approval, we will proceed with the scheduling
process.
Important: You should request a copy of their policy on the surgical treatment
of morbid obesity. Be sure to write down all the details during your conversation.
More details will be covered at one of our monthly seminar. Attend a free Seminar.
Or Contact us, Call us on: 414-281-9665.
Denied by your insurance? Don’t get discourage, here is what you can do:
Appeal:
In the event that your request for insurance coverage of the Lap-Band surgery or
other obesity surgery is denied, you have the option to appeal the denial of coverage:
- Insurance companies require that patients appeal within 30-60 days
after receiving
a denial of coverage notice.
- The appeal should include information that disputes the insurance company's reasoning
for denial of coverage (for example: medical journal articles, copy of patient's
insurance policy, etc.).
Still Denied? It is not the end.
You may seek legal assistance to appeal the denial of coverage, especially if treatment
for morbid obesity (including bariatric surgery) is a covered benefit under your
insurance policy.
The following websites are dedicated to helping patients with insurance authorization
issues and are very helpful resources for patients with insurance concerns:
0ther Payment Options – Self-Financing :
Unfortunately more and more people are finding it difficult or even impossible to
use their health insurance to pay or help pay for weight loss surgery. For those
interested in paying cash or self-financing their surgery,
we offer an all inclusive
package at a very competitive price. Contact Us or call
414-281-9665 and ask for Remy, click:
Self-Financing for more details.
Please feel free to
Contact us with any questions or concerns you may have - we
are here to help!