INSURANCE COVERAGE

Once you have made the decision to have surgical weight loss, getting your bariatric procedure approved by your insurance company is the next step. At Mercy Weight Management Center we work with you and help you understand your insurance benefit and also work with you to obtain all of the clinical information and documentation that is required. Many insurance companies mandate certain criteria that have to be met before any documentation is sent to the insurance company for approval and this is based on the medical policy of the insurance company.

Our program accepts most major insurance plans, so we deal with pre-authorization requirements every day. If you have any questions about your coverage, or are a bit confused, call us at 419-251-8760. We’ll be happy to answer your questions and guide you through every step of the process.

Here are some requirements that your insurance company will need:

• A letter of medical necessity – from your Primary care physician
• Your BMI ( body mass index ) must be 35 or more and you must have at least one of the following;
  • Hypertension
  • Diabetes
  • Sleep apnea
  • High cholesterol
  Or your BMI is 40 or more, without any of the conditions above.
• A psychological evaluation to make sure the patient has a clear understanding of weight loss surgery and the impact it will have on one’s lifestyle. The psychological evaluation also checks for untreated binge eating or any other psychological issues.
• A nutritional evaluation – working one-on-one with a dietician – to outline specific dietary changes and make suggestions on specific habits that need to be changed.
• Complete a three – nine month medical weight loss program supervised by a physician (with monthly weigh-ins) and provided documentation. Your insurance determines the number of months needed.
• Medical clearances

If your insurance carrier will not cover weight loss surgery, and you are interested in being a private-pay patient, please call us at 419-251-8760 and we will go over our private pay rates with you.