What will most insurance companies cover?
As a primary care physician, it is important for you to educate your patient about his or her insurance options. Every insurance carrier and individual plan varies from state to state. Some major insurance companies cover the procedure if it is considered a medical necessity and the candidate meets the NIH guidelines. Other insurance companies will cover a portion of the surgery as long as the candidate meets certain patient criteria. Still, others may exclude weight loss surgery altogether.
How will your patients know if their insurance plan covers weight loss surgery? Inform them that there are a few different ways to find this out:
Call the phone number that is listed on the back of their insurance card.
Contact the human resources department at their place of employment.
Go to the insurance company website and find this information.
Even if their insurance plan covers weight loss surgery, they will still need to pay a substantial out-of-pocket sum. Make sure the patients know their specific plan and their current deductible.
One more important piece of information: Currently Medicare does not cover weight loss surgery (this includes laparoscopic gastric bypass surgery, laparoscopic sleeve gastrectomy surgery, and laparoscopic adjustable gastric band). Please inform your patients of this before they rely on Medicare to cover the cost.