Insurance FAQ
How do I know if my insurance will pay for surgery?
Can I or do I have to get my insurance approved before I come for a consultation?
What is a Global Period?
What happens if down the road my insurance changes?
What happens if my insurance denies the request for pre-authorization?
How do I know if my insurance will pay for surgery?
Call your insurance carrier and ask them if your policy includes “Medically Necessary Weight Loss Surgery”.
Can I or do I have to get my insurance approved before I come for a consultation?
Most insurance policies will pay for an initial consultation even if bariatric surgery is not a covered benefit in the policy. In general, it is the responsibility of the surgical practice (Southern Oregon Bariatric Center) to submit the request for pre-authorization to the insurance company.
One exception would be Tricare Prime which requires a referral authorization for the patient to have an initial consultation. This referral authorization must be requested by the primary care physician (PCP). While we are not preferred providers with Tricare Prime, we are happy to accept it for bariatric surgery patients. Be sure to instruct your PCP’s office when completing the referral authorization request to indicate that there are no other Tricare Prime Bariatric Surgery Providers in the area and that the patient must see a Bariatric Surgeon not merely a General Surgeon.
A Global Period refers to a fixed time frame after surgery within which all standard care is inclusive. For Southern Oregon Bariatric Center, the customary global period for all insurance patients and for privately paying gastric bypass patients is 90 days post surgery. The global period for privately paying LAP-BAND® System patients is 120 days. We have extended the global period for the LAP-BAND® System patients because we have found that they often need an extra appointment or two beyond the first 3-months post surgery to get to their “Green Zone” – the point at which their adjustable gastric band is at a good tightness.
What happens if down the road my insurance changes?
After bariatric surgery, we want to follow you for life at least once each year. If your insurance changes, check with your new insurance carrier to verify your benefits. Then bring your new insurance card to the office and we will be happy to update your records.
What happens if my insurance denies the request for pre-authorization?
There are excellent Obesity Law Advocates available to assist with appealing the insurance carrier’s decision. Each case is different. If you are a patient of ours, we will work closely together to get your insurance approved. You can ask some of our patients to be sure. We don’t give up easily and will make every effort to help you get insurance approval for surgery !!!
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Related Topics:
- LAP-BAND® System FAQ
- Gastric Bypass FAQ
- Laparoscopic Sleeve Gastrectomy FAQ
- Biliopancreatic Diversion (BPD) FAQ
- Duodenal Switch Procedure FAQ
- Out of Town Patient FAQ