Does my insurance cover bariatric surgery?
The best way to determine if you’re covered is to contact Member Services. The number is always listed on your insurance card. If you require assistance at any time, please contact our office and ask for our Insurance Coordinator.
Do I have benefits for surgical treatment of morbid obesity?
The Insurance Coordinator verifies benefits after your initial consultation to obtain information on your benefits, deductibles and how much is met. It usually takes two to three weeks for this process due to the large number of patients.
What do I have to do to get approved?
Insurance companies are required to review medical records prior to making the decision to approve your surgery. They use these records to determine medical necessity, to review your health for surgery, and to see if you can stick to a diet plan. Ask your Member Services representative for a copy of these requirements, or you can find them on their website. These records will come from your prior visits with any and all of your doctors, or new visits with a nutritionist and a psychiatrist.
How is the information gathered and submitted?
After your initial consultation, you will be given a list of what your insurance company requires. It is your responsibility to get this information to the Insurance Coordinator. A list of requirements will be placed in your chart, and as each item comes in, it will be checked off. When all items are checked off, a letter of predetermination will be written and the entire package of records will be sent to your insurance company either by fax or by certified mail.
How long does it take to get approved?
Most insurance companies take 30 to 60 days to go through the approval process. Typically they will send a letter to the office and to the patient informing them of their decision. We contact you as soon as we hear from your insurance company. To check the status of your request, we suggest that you start calling your insurance company approximately three weeks after we submit everything. Due to the number of patients we have waiting to get approved, this office cannot call to check the status. Insurance companies typically respond to their members much better than they do to the providers.
What do I ask the insurance company when I call about approval?
Inform the Member Services representative that you are asking about the letter of predetermination sent from Dallas Bariatric Center, and that you wish to know how long the predetermination process takes. Don’t hesitate to call frequently. Our history shows that persistence on your behalf pays off faster.
How will I know if I am approved or denied?
You will receive a letter from your insurance company, usually before our office receives a duplicate letter. Once we receive notice, we will call you to schedule your surgery.
How do I qualify for this surgery?
The general rule of insurance companies is that your BMI must be 35 or greater with additional co-morbidities such as Hypertension, Sleep Apnea, Coronary Heart Disease, Type II Diabetes, and Dyslipidemia; or your BMI must be 40 or greater without any co-morbidity.
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*CareCredit for Treatment and Care *
We offer CareCredit to make it easier for you to get the treatment and care you want and need. CareCredit, a part of GE Capital, and the nation’s leader in patient financing has a variety of payment plans for you. Depending on your procedure, you can conveniently pay over time with a Low Monthly Payment Plan that fits comfortably into your lifestyle and budget.
Learn more by visiting CareCredit.com or contacting our office. Ready to apply? Apply online for your CareCredit card today.
We are in network with all policies of Aetna, UnitedHealthcare and Cigna.
We accept all plans with out of network benefits also known as PPO plans, i.e., Medicare, Texas True Choice, and Blue Cross Blue Shield.