Insurance coverage of weight loss surgery is a controversial and difficult issue in the weight loss surgery industry. There are inconsistencies throughout the industry not only between different insurance companies, but also within the insurance companies themselves from state to state and from employer to employer. Insurance companies are constantly changing their coverage of the procedures from year to year. They often change what criteria they require the patients to meet.
It’s not surprising then that obtaining insurance coverage is one step in the weight loss surgery process that patients seem to dread the most. Insurance company personnel can be intimidating and confusing with their complex jargon, contradictory rules and strict guidelines. Our role as a program is to help you each step of the way through the insurance process. You and our insurance personnel work together as a TEAM to find out what coverage is available under your specific plan, what criteria needs to be met for prior approval, what records are needed from your medical doctors to help prove medical necessity, etc. Our goal is to help you move through the insurance approval process as quickly and painlessly as possible. This is not always a simple or easy process, but we’ve worked with many different insurance companies and that experience helps a lot. You will be helped though the insurance process by our two experienced insurance case managers assigned to you after your first consultation with the surgeon. You will know at your first consultation what benefits you may have and what are the insurance requirements.
Specific Insurance Plans
If you are calling to find out if we are in-network under your plan, be sure to ask using either KC Bariatric, Dr. Hoehn’s, or Dr. Kowalski’s name. You should always check to see if the hospital is in-network as well. Again, Dr. Hoehn and Dr. Kowalski perform surgery at Shawnee Mission Medical Care in Shawnee Mission, Kansas; Shawnee Mission Outpatient Pavilion at Prairie Star; Heartland Spine and Specialty Hospital in Overland Park, Kansas.
Dr. Hoehn and Dr. Kowalski participate with many insurance plans, essentially too many to list, and the list is constantly changing! Below is a list of the most frequently seen plans, but remember that this list is NOT ALL INCLUSIVE and you should ASK your company if we are in-network under your plan if you don’t see your plan listed.
Insurance for Weight-Loss Surgery
One of the first steps you should take is to find out if you have coverage under your health care plan for weight loss surgery. You can find this out by contacting your benefits department with the number listed on your insurance card. Don’t be afraid to ask questions of your company representative – after all, this is your contract for health care benefits and you have the right to know what is available to you. Ask about coverage for weight loss surgery, specifying the surgery you desire (gastric bypass, gastric sleeve or LapBand gastric banding). You should also ask specifically if you have any exclusions to weight loss surgery on your plan. This can be a separate issue from coverage and an important one, particularly if you are a Blue Cross Blue Shield, Coventry or United Health Care** member. Be sure to write down exactly what information your representative gives you, and who you talked to in case there is a question later.
For all patients, while on the phone with your benefits representative, you should also review what benefits you have for inpatient surgery (Gastric Bypass or Gastric Sleeve) or outpatient surgery (LapBand) i.e. what annual deductible you have, what your maximum out-of-pocket is, etc. You will be expected to pay the usual co-pay amounts for office visits to our surgeons as specialists before your surgery. You should be aware of whether our surgeons or the hospital(s) are in- or out-of–network with your insurance plan as well. If you have any questions about whether our practice or the facilities are in-network or out-of-network under your plan, you should contact your insurance company or check your insurance handbook.
So, Now What?
Once you’ve determined that you’ve got coverage for weight loss surgery under your insurance plan, or you’ve worked out your financial arrangements, you’re ready to register for one of our upcoming free seminars.