Insurance Coverage / Billing Information
A word about paying for surgery: We are In Network with many insurance
companies including Cigna, Aetna, United Health, Blue Cross, Blue Shield and more. We are Medicare providers. Insurance companies have various criteria for approval. They vary greatly even within the same company, as well as company to company. Some policies have what’s called ‘an exclusion’ for bariatric surgery. Others want patients to jump through various hoops before approving surgery. The “how highs” may include proof of attempts at weight loss thru other methods, or medically supervised weight loss diets for example. It can be complicated and challenging, so we have a staff of experts to handle this for our patients. I always tell patients that we are their advocate in health and in seeking insurance approval! Studies show that many companies deny surgery an average of 3x’s before approving. Some patients choose to pay for surgery themselves. We do our best to make this possible for them financially. The monetary cost of Obesity often includes prescription drugs, treatment programs and diet programs. Many cash pay patients report paying for surgery is the best money they ever spent
Insurance Approval Process: Insurance company policies regarding
coverage of bariatric surgery can vary widely. Coastal Center for Obesity's
Billing Specialists will work on your behalf to expedite approval whenever
possible. The information below is intended to answer some of your potential
questions about our approval process.
Common insurances and what they require:
Click here and
select your insurance company at the top of the page.
Anthem Blue Cross
Blue Cross/Blue Shield
Blue Shield of California
MOLINA (Medical Group)
To assist us, patients should provide our office with a copy of
insurance card(s) (front and back) by faxing to :
Once our office receives your Health Questionnaire (available on
New Patient Forms), the
clinical staff will review the information and forward to the insurance
coordinators. We request authorization in a letter of medical necessity,
describing your condition(s) and the surgical procedure(s) to be performed.
The insurance company will then view the request. Some companies require
additional studies i.e. psychological evaluation, nutrition consult, lab testing
etc. Our Coordinating Department may also require additional information and
assistance from you. Please be prepared to provide the following information if
1. Diet history including documentation of attempts at weight loss,
both medically supervised and non supervised.
2. List of current medications
3. List of primary care physicians or specialists treating your medical
4. Supporting documentation of physicians who support your pursuit of surgery
5. Past surgical history with copies of operative reports
6. Days missed from work related to weight condition
7. Psychiatric history
8. Family history
What can I do to help Insurance Approval? This helpful document may
simplify your insurance approval procedure.
Download the document.
If approved, the insurance company typically certifies you for a certain
number of days in the hospital.
If denied, you may have an opportunity to appeal the decision. We are happy to
assist you in the appeal process, at your request. Depending on the reasons for
denial, we may refer you to an attorney who specializes in appeals for bariatric
surgery coverage. If denied, patients may want to pay for their procedure
through other means. The following link may be useful to those of your
considering using a credit union.
Need Assistance with Insurance? Financing?
Financing Assistance available for U.S. Residents
For useful information on how to get financing for your weight loss surgery
please visit our finance
Legal Assistance for Obesity Issues:
www.obesitylaw.com - The
Obesity Law & Advocacy Center is a full-service private law firm devoted to
representing morbidly obese persons in a variety of legal matters. The
firm handles all types of civil litigation with an emphasis in:
Appeal and grievance proceedings challenging the denial
of medically necessary treatment for obesity and morbid obesity.
Employment discrimination, Americans With Disabilities
Act (ADA) and wrongful termination litigation.
Prosecuting insurance and ERISA litigation against
health insurers, self-insured plans and HMOs related to the unreasonable
denial of benefits for treatment of obesity and morbid obesity..
Administrative law hearings and related litigation
against public agencies denying medically necessary treatment of obesity
and morbid obesity.
Personal injury, insurance, employment, general business
and civil litigation.