Contact our office to speak directly with a weight-loss specialist at 808-561-5511.
Insurance and Payment for Your Weight Loss Surgery
What You Should Know About Insurance and Weight-Loss Surgery
Most insurance plans cover at least a portion of the surgery expenses for morbid
obesity. However, there could be out-of-pocket expenses that you have to cover,
from as low as $5 to more than $4,000, depending on which procedure you have
and your insurance company's policies. To avoid misunderstandings, we strongly
encourage you to work with our insurance experts to try to determine your out-of-pocket
expenses.
The following is a list of insurance companies and their current policies
on weight loss surgery. These policies can be changed by the insurance
companies at any time, therefore please use this table only as a guide. Our
insurance office will check for changes in these policies at the time they submit
your authorization request.
Insurance Company |
Procedure |
Approval Criteria |
Blue Cross/Blue Shield (HMSA) |
-Roux-en-Y Gastric Bypass
-LapBand®
-Vertical Gastroplasty/Gastrectomy |
BMI >40 or >35 with significant medical problems |
UHA/HMAA |
-Roux-en-Y Gastric Bypass
-Vertical Gastroplasty/Gastrectomy
-LapBand® |
BMI >40 or >35 with medical problems |
HealthNet |
-Roux-en-Y Gastric Bypass
-Duodenal Switch
-LapBand® |
BMI >40 or >35 with medical problems |
United Healthcare |
-Roux-en-Y Gastric Bypass
-Duodenal Switch
-VerticalGastrectomy/Gastroplasty
-LapBand |
BMI >40 or >35 with medical problems |
Aetna |
-Roux-en-Y Gastric Bypass
-LapBand® (for special indications) |
-BMI >40 or >35 with medical problems
- 3-6 month MD supervised diet |
Cigna |
-Roux-en-Y Gastric Bypass
-LapBand®(for special indications |
-BMI >40 or >35 with medical problems
- 3-6 month MD supervised diet |
If your insurance will not authorize weight loss surgery, we offer a self-pay
option. Contact our main office
toll-free at (866) WLS-DOCS for more information. Difficult insurance questions
will be referred to our insurance experts.
Can I Pay for My Weight-Loss Surgery Myself?
The simple answer is yes. However, our preference is for you to use your insurance
to avoid significant hospital and other related costs. We have a very high success
rate at obtaining authorizations for weight-loss surgery, and are able to get
most insurance companies to pay for most of the hospital charges and some of
the surgeon fees. If you need to self-pay, please email your request to us at
weightloss@lapsf.com and include your
contact phone number. We will contact you to discuss this issue. Please be aware
that most insurance companies do authorize the Roux
en Y Gastric Bypass, LapBand®, and the
Vertical Gastrectomy/Gastroplasty,
while fewer authorize the Duodenal Switch.
Contact us to schedule a one-on-one
consultation with Dr. Cirangle. Call and speak with one of our weight-loss surgery
specialists today at (808) 561-5511.
Links to Web sites that can help you with insurance issues:
In most states, review boards can - and often do - overturn an insurance company's
denial for surgery. The Department
of Managed Health Care Website offers advice on how to seek an independent
medical review (IMR). You can also search a database on morbid obesity to
see what appeals were upheld and which ones were overturned.
Other sites you may find helpful:
www.kff.org
patientadvocate.org
moneycentral.msn.com/articles/insure/health/contents.asp?p=2
moneycentral.msn.com/articles/insure/basics/9962.asp
moneycentral.msn.com/articles/insure/basics/5076.asp
obesity
taxguide
Contact our office to speak directly
with a weight-loss specialist at 808-561-5511 or toll free at (866) WLS DOCS
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