Weight-Loss Surgery Insurance Coverage
Patients often ask about their financial responsibility before weight loss surgery. Insurance benefits may cover some or all of the cost. One of our insurance specialists will review any financial responsibility with you before you have surgery. This may include co-payments, deductibles or out of network fees. At that time the specialist will assist you in making arrangements for payment.
Please contact your insurance company to confirm that you have coverage for a bariatric procedure. Call you insurance carrier and become familiar with the benefits and specific requirements for your approval.
Verification of insurance benefits will be confirmed by a Lenox Hill Hospital, Lenox Hill Insurance Specialist. The complete and accurate information you provide on the Patient Registration Form is very important for us to complete this process.
You may be required to get a referral to one of our bariatric surgeons from your primary care physician. Even if you are not required to get a referral, it is good to have the support of your physician. Our bariatric surgeons will be coordinating care with your physician of choice.
Most insurance companies that cover weight loss surgery require submission of your personal indications showing that you meet their criteria. Required documentation may include:
- Attendance at a free Bariatric Seminar and a consultation with one of our bariatric surgeons.
- Documentation of failed attempts to lose weight through physician-supervised diets. Length of weight loss attempt varies by insurance company. Check with your insurance company for their specific requirements.
- Proof of morbidly obese status for 2, 3, or 5 years.
- Psychological evaluation.
- Nutritional consultation.
- A complete history and physical exam by your primary care provider.
- Patient consent for surgery indicating that you understand the surgery, the risks involved and the alternatives to surgery.
Some weight loss surgery insurance companies require criteria that may vary from the list provided. Whenever possible, our program staff will confirm the requirements and guidelines. Some insurance companies are now requiring proof that you have tried and failed to lose weight on a medically supervised diet for 6 months or, in some cases, a 3 month multi-disciplinary program.
To assist in obtaining insurance approval, Lenox Hill Hospital Bariatric Team will submit your documentation to the insurance company.
Patients will be responsible for gathering any medical records, test results and information needed from outside providers.
Weight loss surgery will be scheduled upon receipt of pre-determination approval from your insurance company.
