Pricing and Payment Options for Bariatric Surgery
Finding out the cost for bariatric surgery, whether or not it will be covered under your insurance plan, or how you will pay for the surgery if it is not covered, is critical before formal enrollment into the program. The following are general guidelines:
Medicare currently covers all of our obesity operations if medically necessary, and only in bariatric programs officially designated as a Center of Excellence. The Middlesex Hospital Center for Bariatric Surgery is an official Center for Excellence. Medicare, however, does not give prior approval for surgery, so a denial is still possible before and after surgery.
Insurance coverage for weight-loss surgery varies depending on the individual patient’s insurance plan. Gastric Bypass and Band surgery is a covered benefit by many insurance companies, depending upon the type of policy you have and its terms. Insurance policies vary even though the same insurance company may have issued them. Patients are advised to review their individual insurance policies to understand what insurance benefits are covered. Financial counseling and pre-authorization from insurance companies needs to be secured before surgery can be performed.
Self-Pay (no insurance coverage)
Some patients may choose to pay for the surgery on a self-pay basis. These arrangements can be made by speaking directly with the surgeon’s administrative assistants. In addition, our self-pay packages include provisions that can protect you from any financial concerns that may arise up to 2 years following surgery in the case of any rare complications.
Insurance applications and appeals are handled completely by our knowledgeable and experienced staff. If you receive a denial of insurance coverage by your insurance company, you should not consider this to be a “definite no.” In many cases, providing additional detailed information, in the form of an appeal letter, will result in a denial being overturned. If your insurance carrier remains unreasonable, you may want to consider writing your legislator or seeking legal assistance. We will counsel you in these matters should they arise. Legal assistance can be obtained through a local attorney, via www.obesitylaw.com.