Speaking to Your Insurance Provider about Weight Loss Surgery at Providence

Many employers are now offering coverage for Bariatric surgery. It is not the insurance company that determines if you have coverage but your employer. Most patients obtain insurance approval to cover the costs of their Bariatric procedure. Some patients choose to pay for the surgery themselves if they do not have coverage offered by their employer or are not employed. We would be happy to discuss self-pay options with you at the time of your initial consultation or feel free to call our office for more information.

Insurance companies are free to establish their own criteria for approval, but like our program, many follow the surgical criteria guidelines of the National Institutes of Health and The American Society for Bariatric and Metabolic Surgery.

Weight Loss Surgery Insurance Approval

Insurance approval is often a lengthy and complicated process. The staff at the Bariatric Care Center will assist you in obtaining insurance approval. However, they cannot act on your behalf since you are the policy holder. Therefore, you will need to work with our staff and remain active in the process.

Below are some steps you can take to ensure you have the best chance of obtaining coverage:

  • Read your insurance booklet and/or speak to the insurance company prior to coming to a seminar to see if you have coverage for Bariatric surgery. The insurance company is required by law to provide you with this information.
  • If you are required to obtain a referral prior to speaking with a specialist, contact your primary care physician and request a referral prior to attending your first appointment. It is always a good idea to consult with your primary care physician anyway, as his or her support is very helpful in the process.
  • Locate your past medical records. Many companies require proof that you have tried other methods of weight loss prior to seeking surgery. A detailed description of the limitations your excess weight places on your daily activities, such as walking, tying shoes or maintaining personal hygiene may be needed for submission to your insurance company.
  • A complete record of your health history must be sent to the insurance company, and your physician must also review that history to make the appropriate decision regarding your case. Therefore, be sure to complete all paperwork and answer all questions as completely as possible.
  • A full description of all your health conditions, including records of treatment, medications taken and documentation of the effects these conditions have had on your everyday life is necessary
The following is a list of insurance companies that the Bariatric Care Center at Providence works with:

  • Aetna
  • Amerigroup
  • Anthem
  • BC/BS DC
  • BC/BS Federal
  • Carefirst
  • Cigna
  • DC Medicaid
  • MD IPA
  • NCAS
  • OPT Choice
  • One Net PPO
  • Unison
  • United Healthcare

Main hospital Phone: (202) 854 7000

Providence Hospital, 1150 Varnum Street, N.E. Washington, DC 20017 2180