Insurance Alternatives For Weight Loss Surgery
What if I Don’t Have Insurance Coverage?
So what can you do if you don’t have insurance coverage or if you have a policy exclusion? You have several options:
- Contact your employer through your Human Resources Department. It is important to remember that health plans provided as part of your employee benefits package are specifically chosen by your employer. Not providing benefits for weight loss surgery is usually an economically-based decision. If your company is self-insured perhaps special arrangements can be made for coverage for you or a “rider” can be added to your plan to cover weight loss surgery.
- Consider changing insurance plans/companies at the next open enrollment period for your employment. Again, lobby your human resources department far enough in advance so they are aware of the need to add weight loss surgery as a benefit on your plan. Enlist other employees to provide more pressure and incentive for your employers to make the change.
- Submit for insurance prior-approval despite your exclusion and go through the appeals process in an attempt to overturn their decision to deny coverage. Each patient has the right to appeal an insurance company’s exclusion or any decision to deny coverage for any reason. There is usually more than one level of appeal involved. Our program cannot assist you with the appeals themselves but can advise you, and insurance appeal experts are available nationally.
Self Pay Option
A significant number of our patients find that their insurance companies do not provide coverage for weight loss surgery and choose instead to privately finance their surgeries. We are always available to explain how the self-pay system works. Please contact our program coordinator to discuss your self pay options or discuss any questions you may have regarding specific charges and fees.
We perform weight loss surgery at Shawnee Mission Medical Center and Heartland Spine and Specialty Hospital. Both facilities have special discounted fees arranged for self-pay patients called “global fees” in which most of the expenses related to your care for the surgery are consolidated. This global fee only covers the initial surgery and the standard care associated with that surgery. Each facility has their own policies regarding what is covered or not covered if the patient would suffer from any complications from their surgery. We are pleased to announce that due in part to our very low complication rates, the facilities’ policies of coverage for complications for self pay patients have recently become much more inclusive. Again, we have copies of hospital policies in our office for you to review should the private pay option interest you. Also, you may contact us by email for quotes on specific procedures, and curent financing options.
Before each of our informational seminars, we spend time discussing the private pay fees involved with the surgeries we perform. Please feel free to attend the 6 to 7 p.m. session to ask any questions you might have.
Important for all patients: If your insurance company does not provide benefits to cover your initial weight loss surgery, whether due to exclusion or other determination, they may not provide benefits for any complications related to your surgery either.
Financing Options
Your personal bank, your mortgage company, and now even on-line internet financing companies can provide you with good alternatives to using your savings to finance your surgery. Many patients are able to plan ahead and use their “flexible spending plans” as part of their health care benefits to help with the cost of surgery. Don’t forget, too, that the cost of surgery may be tax-deductible for certain patients depending on their personal circumstances.
The Bariatric Center of Kansas City does not directly provide a financing program through our office, but some of our patients have had good results using Capitol One’s on-line financing program at www.cosmeticfeeplan.com or call toll-free at 1-888-440-2375.
So Now What?
Once you’ve determined that you’ve got coverage for weight loss surgery under your insurance plan, or you’ve worked out your financial arrangements, you’re ready to move forward with the next step: How to Begin.
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