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Insurance Coverage for Weight Loss Surgery> How do I find out if my insurance policy covers weight loss surgery? How do I find out if my insurance policy covers weight loss surgery?Many local employers have included the benefit of weight loss surgery within your health care plan. To determine if your insurance policy offers coverage for weight loss surgery, call the customer service number on the back of your card. Ask if you have eligibility to have LAP-Band™ surgery or gastric bypass surgery. If you do have eligibility within your plan, inquire if The Jewish Hospital in Kenwood and Dr. Elliott Fegelman are in–network providers for you. The Jewish Hospital as well as Dr. Elliott Fegelman are in-network for many insurance plans in the Cincinnati area. This Center is a Center of Excellence for Bariatric Surgery. We also are an Anthem Center of Blue Distinction for Bariatric Surgery. What do I do next?Your next step is to apply on-line. During this process, you’ll be asked to provide us with your health insurance information. You’ll also need to complete some medical background information. Visit MoreThanADiet.com and follow the links for on-line registration for weight loss surgery patients. Once you’ve applied on-line, the Center will call your insurance carrier and inquire what particular documentation must be submitted to your carrier or order for you to obtain authorization. Simply having eligibility within your plan does not guarantee you coverage. You must go through the process of submitting a pre-determination packet to your carrier. Once the packet is submitted, a medical doctor at your carrier will make the final decision regarding your coverage. What if I have an exclusion on my plan?If your employer has placed a direct exclusion on your medical policy, you will not have coverage for weight loss surgery. Even if your medical doctors write letters in support of the medical need for this surgery, this decision cannot be swayed. Your employer who holds the policy has said “do not cover this surgery” and the insurance company cannot override this decision. Can I pay for surgery myself? Costs for gastric bypass and gastric sleeve are also available. Please call the Center for more information at 513-686-6820. Does the program charge a fee?Every weight loss surgery program has a Program Fee. This fee covers the staff time needed to help you be successful in getting authorization from your insurance company or, if you are self-pay, the process of pulling your documentation together for surgery. It also covers the services you will need pre- and post-surgically to be successful with weight loss. Unfortunately your carrier does not pay for these essential services. They pay for the doctor’s time only. The current program fee is $200. You will be responsible for payment of the program fee prior to the Center submitting your case to your insurance company. If you are a self-pay patient, the program fee will be due prior to a date of surgery being scheduled. Predetermination packetThis is a packet of information submitted to your insurance company to obtain authorization for weight loss surgery. Typically this packet contains documents pertaining to your medical history; surgical history; weight loss history; a psychological evaluation and other supporting documents required by your carrier.
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If you do not have insurance coverage for weight loss surgery, you’ll need to pursue paying for weight loss surgery on your own. If you pay for placement of the LAP-Band™ on your own, the cost is $12,900. This fee includes the surgeon’s cost, the pre- and post-surgical program cost, the hospital fee, the anesthesia fee and your fills for the first year following surgery. If you are looking for a funding source, the Center has a relationship with National City Bank. This bank can assist you in obtaining funds needed to pay for surgery.