The process leading up to bariatric surgery varies depending on each person’s medical history and insurance requirements. Please review the process below for additional information.
Insurance providers and individual plans vary in coverage for weight loss surgery and related services. Each patient is responsible for insurance co-pays and deductibles at the time service is rendered. Our team will work with each patient to verify bariatric surgery coverage. We encourage each patient to also call their own insurance to verify their coverage and financial responsibilities.
WPBI has partnered with Clear Health to offer personalized pricing to patients with an out-of-pocket responsibility. Contact our office directly to learn more.
Conemaugh Health System offers an information seminar either online or in-person. This is to educate individuals on necessary information regarding types of weight loss surgery, criteria for surgery, guidelines for pre-surgery and post-surgery, and lifestyle changes necessary for long-term success. Please register for our Free Educational Seminar via the form here. Once we have reviewed your information and are able to verify your insurance, a team member will contact you to set up an appointment for an evaluation and your schedule your educational seminar. You will be required to complete this seminar, either in-person at our facility, or online, to proceed to the next step.
Prior to surgery you will meet monthly with our nurse practitioner to review labs and testing and to access your progress.
Most insurance plans consider your BMI along with other underlying medical conditions you may have. You may qualify if you have a:
For commercial insurance policies; Contact the customer service number on the back of your insurance card and ask this question exactly. “In my certificate of coverage are there benefits for weight loss surgery for morbid obesity if medically necessary?”
For Medicare and Medicaid; there are benefits for weight loss surgery as long as the criteria is met. There is no need to contact Medicare and Medicaid.
Most insurance companies that require a diet still require the diet no matter how many co-morbid diagnoses you have.
Usually the diet must be followed for at least 6 full months, which is one initial visit and 6 follow-up visits. Your appointments must be consecutive and the diet must be successful.
This means that your particular plan does not have benefits for weight loss surgery, no matter if you meet the medical necessity requirements or not. Your insurance may tell you that you have appeal rights, keep in mind that you will be appealing policy and not medical necessity. If there are no benefits for weight loss surgery it basically means that the benefit was not purchased by your company.
We do offer bariatric surgery for patients who would like to pay out-of-pocket. Please contact us directly for a quote.
Many patients are able to stop using some medications such as those for diabetes or high blood-pressure if these health issues are directly related to their weight. It is recommended that bariatric surgery patients maintain a vitamin regiment indefinitely after their procedure.
Please send an email to mbrubaker@conemaugh.org.