Coastal Center for Obesity, Lap Band, Gastric Bypass, Bariatric Surgery, Weight Loss in Los Angeles and Orange County Call 888-527-5222 for Consultation
   Facebook LinkedIn Pinterest Twitter YouTube      
Home  |  Search
Patient Support

Insurance Coverage / Billing Information

A word about paying for surgery: We are In Network with many insurance companies including Cigna, Aetna, United Health, Blue Cross, Blue Shield and more. We are Medicare providers. Insurance companies have various criteria for approval. They vary greatly even within the same company, as well as company to company. Some policies have what’s called ‘an exclusion’ for bariatric surgery. Others want patients to jump through various hoops before approving surgery. The “how highs” may include proof of attempts at weight loss thru other methods, or medically supervised weight loss diets for example. It can be complicated and challenging, so we have a staff of experts to handle this for our patients. I always tell patients that we are their advocate in health and in seeking insurance approval! Studies show that many companies deny surgery an average of 3x’s before approving. Some patients choose to pay for surgery themselves. We do our best to make this possible for them financially. The monetary cost of Obesity often includes prescription drugs, treatment programs and diet programs. Many cash pay patients report paying for surgery is the best money they ever spent

Insurance Approval Process:

Insurance company policies regarding coverage of bariatric surgery can vary widely. Coastal Center for Obesity's Billing Specialists will work on your behalf to expedite approval whenever possible. The information below is intended to answer some of your potential questions about our approval process.

Common insurances and what they require:
Click here and select your insurance company at the top of the page.

Aetna
Anthem Blue Cross
Blue Cross/Blue Shield
Blue Shield of California
CCN/First Health
Cigna
Great West
Medicare
MOLINA (Medical Group)
Tricare
United Healthcare


To assist us, patients should provide our office with a copy of insurance card(s) (front and back) by faxing to :
714-997-4449


Once our office receives your Health Questionnaire (available on www.coastalobesity.com- New Patient Forms), the clinical staff will review the information and forward to the insurance coordinators. We request authorization in a letter of medical necessity, describing your condition(s) and the surgical procedure(s) to be performed.

The insurance company will then view the request. Some companies require additional studies i.e. psychological evaluation, nutrition consult, lab testing etc. Our Coordinating Department may also require additional information and assistance from you. Please be prepared to provide the following information if necessary:

1. Diet history including documentation of attempts at weight loss, both medically supervised and non supervised.
2. List of current medications
3. List of primary care physicians or specialists treating your medical conditions
4. Supporting documentation of physicians who support your pursuit of surgery
5. Past surgical history with copies of operative reports
6. Days missed from work related to weight condition
7. Psychiatric history
8. Family history

 

What can I do to help Insurance Approval?

This helpful document may simplify your insurance approval procedure.

- Download the document.

If approved, the insurance company typically certifies you for a certain number of days in the hospital.
If denied, you may have an opportunity to appeal the decision. We are happy to assist you in the appeal process, at your request. Depending on the reasons for denial, we may refer you to an attorney who specializes in appeals for bariatric surgery coverage. If denied, patients may want to pay for their procedure through other means. The following link may be useful to those of your considering using a credit union.

Need Assistance with Insurance? Financing?

Financing Assistance available for U.S. Residents

For useful information on how to get financing for your weight loss surgery please visit our finance section

Legal Assistance for Obesity Issues:

www.obesitylaw.com - The Obesity Law & Advocacy Center is a full-service private law firm devoted to  representing morbidly obese persons in a variety of legal matters.  The firm handles all types of civil litigation with an emphasis in:

  • Appeal and grievance proceedings challenging the denial of medically necessary treatment for obesity and morbid obesity.

  • Employment discrimination, Americans With Disabilities Act (ADA) and wrongful termination litigation.

  • Prosecuting insurance and ERISA litigation against health insurers, self-insured plans and HMOs related to the unreasonable denial of  benefits for treatment of obesity and morbid obesity..

  • Administrative law hearings and related litigation against public agencies denying medically necessary treatment of obesity and morbid obesity.

  • Personal injury, insurance, employment, general business and civil litigation.

www.obesitylaw.com