“I could have made no better investment in myself than my bariatric surgery. It is one of the best decisions I have ever made and I have never looked back,” said Christine Price, Longstreet Clinic gastric sleeve patient.
Whether paying out of pocket or through an insurance provider, bariatric surgery is a big decision. However, it can also be one of the best decisions you’ll ever make. As one of the busiest bariatric surgery practices in Georgia, our experienced bariatric coordinators can help walk you through your payment options and help you assess your cost and insurance coverage. They are here to serve along-side your physician as your navigator throughout your weight loss journey- helping you through the insurance approval process and other logistics associated with preparing for surgery.
When it comes to bariatric surgery, insurance coverage can be a drawn out and frustrating process. Our experience can help, but so much relies on your individual policy. If you have health insurance, the first step you should take is to confirm whether your insurance covers bariatric surgery. While our program is recognized as a Blue Cross Blue Shield Blue Distinction Center for Bariatric Surgery, an Aetna Institute of Quality, and Cigna Center of Excellence, all carriers and all insurance policies have different coverage guidelines and different exclusions. You might try asking your insurance company, “Is weight loss surgery a covered benefit for the treatment of morbid obesity, diagnosis code E66.01″ You may get an accurate answer, but you may have to speak to several different people before someone will actually look into your specific policy.
We pride ourselves in providing high-quality care as efficiently as possible for our patients. If your procedure is self-paid, we offer the lowest in-hospital setting sleeve gastrectomy pricing in the state of Georgia ($15,500) at a MBSAQIP Accredited Center for Bariatric Surgery. This cost includes the surgeon fee, facility fees, anesthesia costs, surgical assistant fee and follow up visits for the first 90 days after surgery. Weight loss patients that meet certain criteria (related to age, BMI, and limited patient co-morbidities) may qualify for our outpatient sleeve gastrectomy option starting as low as $12,900.
Payment Plans and Financing Options
We do offer cash payment options and payment plans in certain cases. In addition, pre-payment plans where a patient can pay incremental payments for up to 12 months prior to a scheduled surgery. One of our staff members can answer any questions you may have.
In addition, we do provide several patient financing options:
Our experienced team of bariatric coordinators can help walk you through exploring your payment options.
Here are some common questions patients have about paying for bariatric surgery.
Why does it take so long to get insurance approval?
After we submit the letter of pre-determination, most insurers have a standard time that they are allowed to process a non-emergency request, usually up to 30 days. Most insurers take the maximum time.
We’re familiar with the criteria and guidelines of most insurance plans and, if necessary, we’ll research your insurer’s requirements. But we encourage you to get involved in the process and call your insurance company regularly about your request. If you have questions, please call your carrier. When we hear from your insurer, we’ll contact you right away.
What is a letter of pre-determination or pre-certification?
A letter of pre-determination or pre-certification from your insurance company means their medical review department has decided, based on the information provided, that your surgery is medically necessary. But this does not mean they will cover your surgery. That depends on your individual insurance policy.
We will submit the necessary documentation to your insurance company. Please do not ask any other physician to submit anything directly to your insurance company. They can provide necessary documentation to us, and we will submit everything as the insurance company requires.
How can they deny insurance coverage for a life-threatening disease?
You may have a specific exclusion in your policy for obesity surgery or “treatment of obesity,” which reflects the prejudice of our society toward obesity. This exclusion normally cannot be challenged or overturned. You may be able to get an exception by going through your employer’s benefits division.
Coverage may also be denied for lack of “medical necessity,” meaning it’s not deemed a serious or life-threatening condition. Instead, alternative treatments, such as dieting, exercise, behavior modification, and some medications, may be considered to exist according to conventional wisdom. To avoid denials for this reason, be sure to include reasonable, thorough documentation to encourage them to approve your request.
What can I do to help the process?
First, help us to get all your information together (diet records, medical records, medical tests), so the carrier cannot deny for failure to provide information. Letters from your physician and consultants attesting to the “medical necessity” of treatment are particularly valuable.
After we submit the pre-determination letter, we encourage you to call your carrier regularly and ask about your request. You may also be able to protest unreasonable delays through your employer or human relations/personnel office.
Keep in mind that most doctors and hospitals require that patients pay a large portion or all of their co-payments and deductibles before surgery. Patients need to be prepared financially and be aware that they may receive bills from doctors, the hospital, the anesthesiologist and any other health care providers involved with their case.
Where do I go for answers about my insurance policy or carrier?
The customer service number for your insurer will be on your insurance card. You can also visit the insurance company’s website, read the most recent insurance handbook from your employer or insurer, or talk to your supervisor or human resources department for questions about your health insurance.
It is important to understand the terms, conditions and limitations of your coverage. If you have questions about your coverage, contact your employer’s human resources department or your insurance company directly.
For more information on weight loss surgery, click here.
Our accredited program offers a full service, unique weight loss experience. Learn more here.