Insurance and Financing Options
Your Payment Options
After you have spent a considerable amount of time exploring the options of surgery, your next consideration will be to determine how to pay for the procedure. ALSA contracts with most insurance companies. If you have any questions as to whether ALSA is contracted with your specific insurance carrier, please contact the insurance directly to inquire.
Most insurance companies provide benefits for weight loss surgery for patients that meet the National Institutes of Health surgical criteria. The best chance for obtaining insurance authorization is to understand the criteria of your specific health plan. ALSA will work with you to guide you through this process. Here are some key steps you should take to obtain insurance coverage for your weight loss surgery:
- Read and understand the “Certificate of Coverage” that your insurance company is required by law to provide to you. If you do not have one, consult your company’s benefit administrator or ask your insurance company directly.
- You may be required to start with your primary care physician. In some cases, he or she is the only one that you can ask for a referral to ALSA. Even if you are not required to obtain a referral, it is a good idea to have the support of your primary care physician.
- Before visiting ALSA, organize your medical records, including your history of dieting efforts. They will be valuable documents to have at every stage of the approval process.
- Document every visit you make to a healthcare professional for obesity-related issues or visits to a supervised weight loss programs. Document “other” weight loss attempts made through diet centers and fitness club memberships, including receipts.
Once you have your initial visit with an ALSA surgeon and if weight loss surgery is recommended for you, we will work with you to obtain all the documents and pre-surgical tests and visits required by ALSA and your insurance company. Some of the requirements include a visit with a nutritionist and psychologist to ensure you’re ready for surgery. Other tests can include a mammogram, colonoscopy, upper GI, cardiac evaluation and blood tests.
After the pre-operative requirements have been met, ALSA will prepare a letter to your insurance company to obtain pre-authorization for your surgery. The goal of this letter is to establish the “medical necessity” of weight loss surgery and to obtain approval for the procedure. Two to three weeks is the standard time for an insurance company to respond to the pre-authorization request. It is possible that the process can take longer, or that your insurance company will require further documentation or additional testing before an authorization request will be approved.
Even if your initial request for pre-authorization is not approved, you still have options available. Insurers provide an appeals process that allows you to address each specific reason that they have given for denying your request. It is important that a reply is sent to the insurance company quickly. It is also important that you clearly understand the appeal rules of your specific plan. While ALSA cannot initiate the appeal, we will do what we can to help supply you with supporting documentation.
If you do not have medical insurance, or coverage for the procedure is an exclusion on your plan, ALSA has cash pay options available. We have partnered with Fresno Heart and Surgical Hospital to offer cash pay packages that include most of the fees for weight loss surgery. If you are interested in our cash pay package, please contact our office and one of our team members will contact you directly to give you additional information.