Billing & Insurance
Qualifying for insurance coverage
We understand that dealing with health insurance during a hospital stay can be a stressful process. Our goal is to ensure that you receive the most efficient service and are well informed about all aspects of your bariatric procedure, including your insurance coverage.
Since every insurance policy is unique, it's important that you thoroughly understand your certificate of coverage to know exactly what is and isn't covered through your plan. To qualify for insurance coverage, many insurers require patients to have a history of medically supervised weight loss efforts.
Keep track of every visit you make to a healthcare professional for obesity-related issues or visits to supervised weight loss programs. Make note of other weight loss attempts made through diet centers and fitness club memberships and keep good records, including receipts, as these will help you qualify for insurance coverage.
If we recommend that you have bariatric surgery, we will prepare a letter to obtain preauthorization from your insurance company. The goal of this letter is to establish the medical necessity of bariatric surgery and gain approval for the procedure. The following information is generally included in the preauthorization letter:
- Your height, weight and Body Mass Index, and any documentation you might have as to how long you have been overweight
- A full description of all your obesity-related health conditions, including records of treatment, history of medications taken, and documentation of how these conditions affect your everyday life, is necessary—simply describing your condition as morbid obesity is not enough
- A detailed report of how your excess weight affects your daily activities, such as walking, tying your shoes or maintaining your personal hygiene
- A detailed history of the results of your dieting efforts, including medically and non-medically supervised programs, medical records, and records you may have kept of payments to and meetings you've attended with commercial weight loss programs
- A history of exercise programs, including receipts for gym memberships
- Ask your doctor to include clinical information about how effective bariatric surgery can be, particularly the control or elimination of obesity-related health conditions
Normally, your insurance provider will respond to your request within 30 days. Once we receive authorization from your insurance carrier, we will call you to set up an appointment. If your insurance company denies your request, we will help you make an appeal.
At the end of this stage, with the help of our team, you will know if you qualify for bariatric surgery.
Following surgery, you can pay your bill online. If you have any additional questions regarding billing or insurance, contact us at 585.922.1900 or toll-free at 866.209.0949. We're available Monday - Friday: 9 am - 4:30 pm.