Insurance and Financing
Get the Process Started
Most insurance plans cover bariatric surgery. Our expert team will help guide you through the insurance process in order to get your surgery approved. Many insurance policies differ from plan to plan; therefore our team will assist you in understanding your benefits and requirements for bariatric surgery. Commitment and dedication is required during this process to help achieve your goals.
After attending the information session, you will meet with our Bariatric Program Coordinator at your NEWU appointment in order to start the insurance process.
Questions to Ask Your Insurance Company
As the bariatric insurance process can sometimes be confusing, you may want to review your insurance benefits prior to your NEWU appointment. Here are some questions that you can ask your employer’s Human Resources Department and Insurance Company:
Is my insurance policy sponsored as a self-insured plan or a fully insured plan?
If your employer plan is fully-insured, the insurance company is ultimately responsible for the health care costs, and the employer typically purchases a standardized package of coverage from an insurance company. In a self-insured plan, your employer is ultimately responsible for the health care costs, and therefore can customize the plan to include and exclude specific coverage, such as bariatric surgery coverage.
A key difference is that fully insured policies are governed by your state insurance commission, while an employer’s plan (self-insured) is governed by the Federal Government through the Employee Retirement Income Security Act (ERISA) laws and regulations. If your self-insured employer does not cover bariatric surgery, you may want to write them a letter explaining how this disease has affected your life in order to obtain support for bariatric surgery. These differences affect how you approach your insurance provider and employer in this process. The Chicago Center for Bariatric Surgery & Medical Weight Loss will assist you in navigating the insurance process and policy requirements and options for pursing surgery.
Does my policy cover Weight-Loss Surgery for Morbid Obesity?
Request a copy of your insurance policy. These documents can either be provided from your employer or insurance company, and may be written in legal style format. (Many large employers have Benefits Websites where all of the plan documents can be found.) These documents explain your enrollment with the provider, such as whether you are enrolled in an HMO, PPO, or indemnity plan.
In regards to morbid obesity exclusions, request that your insurance provider highlight the sections in your plan that discuss the exclusions and mail/fax you a copy. Please provide a copy to our Bariatric Program Coordinator at your NEWU appointment. She will assist you with understanding the requirements for bariatric surgery. If the insurance representative refuses to do this, thank them for their time, hang up and call again.
Does my Weight-Loss Surgery benefit require a Medically Supervised Weight-Loss Trial Program?
If yes, please list what is required in order to have surgery, including the number of months of medical supervision; for example, there is a certain amount of required time that I must document attempted weight-loss. The following are common requirements by insurance companies in order to have weight-loss surgery:
- BMI greater than 35 with one or two comorbidies (hypertension, osteoarthritis, sleep apnea, Type II Diabetes, etc.); or BMI greater than 40
- Three to six months of CONSECUTIVE medically supervised weight-loss trial (either by your Primary Care Physician or Registered Dietitian)
- Evaluation by a Registered Dietitian and Exercise Specialist
- Evaluation by a Psychologist for well-being
- Evaluation by a Cardiologist or Pulmonologist
- Sleep Study evaluation and other diagnostic tests
Other questions you may want to ask your insurance company:
- Are there weight limitations preventing coverage?
- Is there a maximum dollar limit on my benefits?
- What treatment options are excluded or specifically included?
- What is the co-payment for medical services?
- What testing is covered, such as nutritionist, psychologist, labs, sleep apnea study, ultrasounds, etc.?
- Does your insurer require weight loss prior to surgery? If so, what percentage or number of pounds is required?
Want to Learn More?
Attend a FREE Weight Loss Surgery Information Session.
7411 Lake Street,
Building A, Suite 2100
River Forest, IL 60305 River Forest Medical Campus