Studies show that weight loss to control obesity can significantly reduce healthcare costs, and many insurance companies are taking notice. Some plans, including Medicare, now cover bariatric surgery and related medical care.
Each health insurance plan varies in the coverage they offer for bariatric surgery and medical weight loss programs. Loyola Medicine is committed to working with you to determine whether your insurance covers your medical weight loss needs. Loyola’s pre-certification specialists assist you in contacting your insurance carrier to acquire approval.
To begin your weight loss journey with Loyola, we invite you to attend one of our free in-person or on-line weight seminars. When you participate in one of our informational seminars, our specialists will obtain your necessary insurance information and will do a preliminary coverage check with your insurance carrier. Following the seminar, our pre-certification specialist will contact you with details of your coverage, including:
- If your policy will cover weight loss surgery
- How much you may be expected to pay out-of-pocket
- Any additional requirements for coverage you may have to meet
Most insurance companies require extensive documentation regarding your past attempts to lose weight, as they determine whether or not to finance your weight surgery. In preparation, we ask that you gather the following information:
- Medical documentation of a five-year weight history
- Any actual documentation of diet drugs and medically supervised diets prescribed
- Any commercial diet program records (examples: Weight Watchers, Jenny Craig)
- Any exercise program records (examples: YMCA/YWCA, gym membership)
We urge you to gather your necessary records as soon as possible, so they are available when we talk with your insurance company. Your insurance company will require official documentation of attempts at weight loss.
If you have a weight history and weight-treatment history at Loyola Medicine, Gottlieb Memorial Hospital, we will gather that weight information and the weight loss drugs prescribed by our doctors from your Loyola medical record.
For your weight history outside Loyola Medicine, you will need to contact the doctor who weighed you and/or prescribed weight-loss drugs for a copy of that documentation. A summary letter from the doctor of dates, weights, medications prescribed and supervised diets is acceptable. You may also need to contact the offices of commercial diet program for records.
After we have gathered your weight history, test results, documentation of exercise programs and other records, we will analyze them and submit a letter of recommendation to your insurance carrier, requesting approval for coverage of the procedure. Your medical records are sent to your insurance company with the letter.
Some insurance companies will make the decision about your weight loss surgery within a few weeks; some take several weeks or months to return a decision. We will contact you when we have heard from your insurance company. If your request for coverage is denied, our financial counselor will discuss appeals and self-pay options with you.
The insurance companies listed below are only a summary of those accepted by Loyola Medicine. If your insurance appears here, it does not guarantee that you have bariatric coverage or that you will be accepted into the bariatric program.
Depending on the rules of your health insurance plan, there may be additional requirements for coverage, including participation in a medically supervised weight loss program. Please read more about insurance plans accepted at LUHS.