“Will my insurance company pay for weight loss surgery?”

This is one of the most common questions we hear from individuals considering a bariatric procedure. If you are thinking about having weight loss surgery in Denton with Dr. David Provost,  we will verify your insurance benefits prior to your complimentary information session.

At the Bariatric Information Seminar, you will meet with Dr. Provost and our financial coordinator. You will be given your specific mandated insurance criteria, such as a 5 year physician-documented history of obesity, 3-6 months of physician- supervised weight loss, 3-6 months of dietitian-supervised weight loss, psychological evaluation, and any medical clearances. Some insurance companies may require more information.  The sooner you complete the criteria and send it to us, the sooner we can get you to surgery.

If your insurance company will not cover bariatric surgery, our financial coordinator will call you and discuss cash pay options.

If you do not have any criteria to meet, call the office at 940-323-3450  to set up an initial surgical consult.

If you have insurance mandated criteria to meet, be sure you and your primary care physician carefully reads the directions for documentation of the 3-6 months of medically supervised weight loss. To ensure correct documentation, fax your physician’s first office visit note to the insurance coordinator at Dr. Provost’s office. After completion of the second to last month, please call our office to set up an initial surgical consult.

If you have any psychiatric or medical clearances to obtain, please obtain these before your initial surgical consult. Bring these records with you to your first visit or fax this information to our insurance coordinator.

At your initial surgical consult, Dr. Provost will explain the details about weight loss operations, including risks/ benefits and dietary changes that can be expected, as well as answer any questions you may have. Once all documentation is received, we will contact your insurance company to obtain approval. This may take up to 30 days, and appeals may be necessary. Once written approval has been obtained through our office, the bariatric nurse coordinator will contact you regarding scheduling a surgery date. Typically, 2-7 business days prior to your date of surgery, a pre-operative appointment will be necessary.

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• Physician/Dietician Supervised Weight Loss
• Pre-Operative Psychological / Psychiatric Evaluation

Many insurance carriers require patients to complete a pre-operative psychological evaluation as part of the approval process for bariatric surgery claims. Our Financial Coordinator will obtain your specific bariatric benefits and pre-determination requirements prior to your first consultation, so we can assist you in meeting the guidelines established by your carrier.

The Bariatric Pre-Operative Psych Evaluation is an objective psychological evaluation performed by a mental health professional (psychiatrist or psychologist) experienced in the evaluation and management of bariatric surgery candidates. Psychiatric evaluations are insurance-specific and are a pre-determination requirement of almost ALL insurance carriers. This evaluation must be completed and sent to our office before we can submit for bariatric surgery coverage approval from your insurance carrier.

For your convenience, we can provide you with a list of experienced practitioners we have used in the past. However, please verify their appropriateness and in-network coverage on your own. Please be sure whichever provider you see is comfortable with performing this type of evaluation.

Also, please note that if you have a history of severe mental illness (bipolar disorder, depression with psychotic episodes, history of suicide attempt or psychiatric hospitalization in the past 2 years, schizophrenia schizoaffective disorder, or personality disorder) you MUST have a clearance from a psychiatrist (MD) only. Furthermore, depending upon your insurance carrier (such as Medicare), the above conditions are almost always an exclusion to your bariatric surgery being covered.

After you have completed the Psych Evaluation, please fax this documentation to KC Stone, Financial Coordinator at (940) 323-3451, so she can ensure the documentation is thorough and correct.

Failure to have the proper documentation by an appropriate provider may result in you having to complete the Psych Evaluation again (if you want your insurance carrier to cover the cost of bariatric surgery).

Prior to approving your weight loss surgery, your insurance carrier likely will mandate that you must participate in a medically supervised weight loss program.

Please have your Physician and/or Registered Dietician see you once a month with no more than 1 week between each appointment for the required number of consecutive months. This requirement must completed within 12 months prior to surgery. (Our financial coordinator will let you know whether you need to see one or both.)

At each visit, your physician must document ALL of the following information on a progress note:

1. the date of your visit
2. a complete set of vital signs including height, weight, and BMI
3. your current diet program (e.g., low calorie diet, Optifast, Weight Watchers, Sugar Busters, Body for Life, etc.)
4. your exercise program, including the type of exercise, how much, how often
5. any behavioral changes to reinforce healthy eating and habits (e.g., eating three meals a day, sitting down at meals, no carbonated beverages, etc.)
6. any consideration of pharmacotherapy
7. your goals (dietary/exercise) for the next month; documented exercise is required

After you have completed 1 month, please fax this documentation to our Financial Coordinator, KC Stone, at 940-323-3451, so she can ensure the documentation is thorough and correct. Failure to have the proper documentation may result in you having to complete the medically supervised weight loss again (if you want your insurance provider to cover the surgery).

When you have completed at least 4 months of a medically supervised weight loss program, please call the office to set up your initial surgical consult with Dr. Provost at 940-323-3450.

In order to submit your bariatric surgery for insurance approval, you must complete ALL of  the program as well as provide documentation of any other insurance or medically required information such as:

• Five-year history of morbid obesity, 1 visit from each year, with weight, date, and doctor’s signature
• Psychological evaluation
• Physician and/or dietician consultation
• Any required medical clearances or tests

If you have any questions, please feel free to call KC in Dr. Provost’s office at 940-323-3450.