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Recognized as a Center of Excellence by the American Society for Bariatric & Metabolic Surgery
Insurance Carriers and Requirements
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Patients should check to see if their insurance provider requires documentation of medical attempts to lose weight prior to surgery.
Some insurance carriers require six consecutive months of documented weight loss attempts within the last two years. Patients’ primary care physicians can help them complete necessary documentation, which may include:
- Vital signs (must include weight)
- Discussion of and suggestions for current dietary program
- Discussion of physical activity or exercise program and recommendations
- Discussion of behavioral modification, including successful changes made
- Discussion of or use of FDA approved pharmacotherapy, if appropriate
Please note that these are just guidelines. Specific requirements vary according to insurance plans.
Insurance companies that do not require documentation of physician supervised weight loss attempts:
Insurance companies that require six months documentation of physician sponsored weight loss:
- CIGNA
- Aetna
- Medicaid
- Medicare
- Medicare Access (Medicare Replacement Plan)
- Tricare
- Most out-of-state Blue Cross Blue Shield plans require three to six months of documentation
The following plans require six months documentation of physician sponsored weight loss and six months documentation of weight management:
- Duke Select
- Duke Blue Cross Blue Shield (Blue Care Plan)
Weight management programs can include Weight Watchers, Pathways to Change (Live for Life), or the Duke Diet and Fitness Center. A $4,000 copay is required before surgery.
What if my insurance will not cover weight loss surgery?
If your insurance carrier will not cover weight loss surgery there are options you can take if you still wish to proceed with surgery:
- Self-pay, or paying out of pocket, is an option for all surgical procedures. Contact the clinic to inquire about rates. There is also a new option for self-pay gastric banding patients to receive surgery at the James E. Davis Ambulatory Surgical Center.
