Bariatric Weight Loss Surgery Insurance Information

Insurance coverage varies for weight loss surgery procedures. Our insurance coordinator will work with you to determine your benefits and help you get the coverage you need. Your coverage is between you and your insurance company.

You will need to call your insurance company to determine if your policy covers surgical weight loss. Your coverage is between you and your insurance company. Working with you every step of the way, our insurance coordinator will help you organize the information you need and work with your insurance carrier. We will help you present your claim but you must take ultimate responsibility for your account. Should your insurance company deny coverage, we will actively work with you to appeal the decision.

Preparing Your Information For Approval

In reviewing your request for coverage, most insurance companies will require extensive documentation regarding your attempts to lose weight in the past. In preparation we ask that you gather documentation of any previous diet drugs and medically supervised diets you have been prescribed.

• You will need to begin gathering these records now so that these are available when we communicate with your insurance company. It is not enough for you to simply list these items on the patient health questionnaire. The insurance company will require official documentation of attempts at weight loss.
• If you have a weight and weight treatment history at UPMC in Central Pa, we will gather that weight information and the weight loss drugs prescribed by our doctors. For treatment history outside of UPMC or its satellite offices, you will need to contact the doctor to release your medical records to us.
• If your insurance changes or terminates you will need to call your new insurance company to determine if your policy covers surgical weight loss. Here is a tool to use for this process. Please bring this form to your next appointment or contact the office with this information.

Getting Approved

Once your test results, consults, weight history, diet and exercise program documentation and other records have been received and reviewed by our office, we will submit a letter of recommendation to your insurance company requesting approval for the weight loss surgery procedure. Your medical records are forwarded to your insurance company with this letter. The insurance company will let us know if there is any additional information they will need to make the decision to approve or deny your weight loss surgery.

Some insurance companies will make the decision about your weight loss surgery within a few weeks. Others may take up to one month to return a decision. We will contact you when we have heard from your insurance company. You may contact your insurance company to check on the status of your insurance approval.

Appeals and Self pay

If you're insurance company denies the request for coverage of your weight loss surgery procedure, our insurance coordinator will request a peer to peer with the medical director of your insurance company or discuss appeals and self-pay options with you.

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Phone: 717-909-0290

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