Insurance Coverage

Qualifying for Surgery with Your Insurance Company

Before your consultation, you should contact your insurance company to make sure your plan covers weight loss surgery.  Here are some tips:

  • Call the customer service number on your insurance card.
  • Tell the customer service representative you are interested in Gastric Bypass/LAP-BAND® surgery and ask if the service is covered on your plan. You may have to phrase this differently such as - morbid obesity surgery, weight loss surgery, or bariatric surgery.
  • If they say the service is not covered or is excluded, this means your employer or whoever you get your insurance through, did not pay for this benefit.  You may contact our office regarding cash pay options.
  • What will my co-insurance and deductible be for bariatric surgery?  Is there an out-of-pocket maximum you pay for this procedure? Is there a lifetime maximum for weight loss surgery?
  • If they say yes or tell you that it must be deemed "medically necessary".  Ask the following questions:
    •  What are your BMI requirements?
    • Do I have to have certain co-morbid conditions (medical conditions related to your weight?)  If so, what are the conditions?
    • Do you have a list of approved mental health providers?
    • Do I have to complete a physician supervised diet, and for how long?  Does the program need to include an exercise component?
    • Do I have to see a dietitian?
    • Do I need to complete a sleep study?
    • Do I need to obtain any cardiac testing?
    • Do I need any pulmonary testing (pulmonary function tests)?
    • Do I need to have certain blood work drawn?
    •  Are there any other requirements?
    • Can you provide me with a checklist (the requirements for surgery)?

    Please contact our insurance department if you have any questions: 515-241-2250.

    Physician-Supervised Diet - Information for Patients

    Please be advised that every insurance plan is different.  We strongly encourage patients to contact their insurance companies to see what is required for their pre-approval.  Here are some general guidelines regarding a physician-supervised diet.

    Q.What is a physician-supervised diet?

    A. A physician-supervised diet in its most basic form is when a patient meets with their family physician every month for a period of time to discuss their weight loss goals, an exercise plan, nutritional changes, and have their current weight and height documented.  It is important that the physician thoroughly documents everything that is discussed at these visits in the patient's chart.  Some insurance companies require patients to be on these diets for a certain period of time before surgery; others require patients to also meet with a dietitian or nutritionist.  If this is a requirement of your insurance plan we can not submit your pre-approval until this diet is completed.

     Q. I think that I have already completed a physician-supervised diet. How can I be sure?

    A. Contact your physician and ask if this diet was documented in your medical records.  If it was and it was within the past three years, have those records sent to our office.  Don't forget to contact your insurance company because their requirements may be different than what you have already completed.  

    Q.  Is a letter from my physician good enough?

    A. Again, check with your insurance company to see what they require for insurance approval.  Most insurance companies will require more than just a letter.  Insurance companies want to see that the patient and the doctor met routinely in the office and most also want to track fluctuations in weight from visit to visit.  It is nice, however, to have a letter of support from your family physician to send with your pre-approval.