Many insurance policies and Medicare cover surgical treatment of morbid obesity, and we do participate with most types of insurance here at Sibley. We will assist you with a preliminary verification of insurance benefits. This will be discussed following your initial office consultation. During this financial consultation, we will also review the specific requirements your insurance company has prior to approving your surgery.
Each insurance company, and even each individual insurance policy, has specific requirements that patients will need to complete prior to being approved for bariatric surgery. Due to these requirements, the time to surgery can be as long as 6-8 months from the initial consultation.
Potential Insurance Policy Requirements
Some or all of the following requirements may be necessary:
- 3, 6, or 12 consecutive months of a Medically Supervised Weight Loss (MSWL) program with a nutritionist or medical professional. Some policies will accept two 3-consecutive-month MSWL programs.
- Programs typically must be completed within 2 years of projected surgery date.
- Weight Watchers or Jenny Craig with documentation / booklet / receipts may be accepted in some instances.
- Some insurance carriers require a letter outlining previous weight loss attempts and recommendation for surgery from Primary Care Physician.
- Medical Clearance (Surgeon, Primary Care Physician, and Specialist if applicable)
- Mental Health Evaluation
- Lab testing
- Insurance companies generally will not accept self-directed programs such as Atkins or South Beach. In addition, regular doctors' visits for other medical issues are also not typically accepted as proof of MSWL.
If you do not have documentation, you can complete Medically Supervised Weight Loss with our Center.
We work with you to compile this documentation and we submit it to your insurance company on your behalf. Upon submission, the Insurance Reviewer can take 3-14 days before issuing final determination for authorization. Once insurance approval is granted, our Surgical Coordinator will contact you to schedule your surgery date.
Sibley Self-Pay Package
If you do not have insurance or if your insurance does not cover weight related services (Policy Exclusion), we can assist you in identifying financing options to help you achieve your weight loss goals. We do offer a discounted self-pay package for bariatric surgery. In general, self-pay patients are able to schedule surgery sooner because they do not have to compile additional documentation for the insurance company and wait for insurance approval. Typically, self-pay patients can be scheduled for surgery within 4-8 weeks after their initial consultation.