Verify Insurance Coverage

Your insurance coverage paves the way for your weight loss journey. With the help of an authorization specialist, Ascension Saint Thomas will guide you every step of the way. However, we encourage you to be as prepared as possible with all insurance-related matters. Below is a helpful list of topics and resources to consider.

Insurance Coverage Considerations

Bariatric surgery coverage varies by health insurance policy, but there are several considerations to take into account regardless of your provider. To qualify for any weight loss procedure, you must be at least 18 years old and have a Body Mass Index (BMI) of 35 or higher. If your BMI is less than 40, you must suffer from a major, weight-related health issue to qualify for surgery. If your BMI is more than 40, you do not need to suffer from a weight-related health issue to qualify.

Most insurance plans also require a physician-supervised weight loss trial and a copy of one office visit note for each of the last 3 to 5 years listing your weight, to demonstrate your obesity has been a long-term health issue. Your provider will have more details.

Insurance Liability for Payment

Your health insurance company will only pay for services that it determines to be reasonable and necessary. Every effort will be made by this office to have all services and procedures covered by your health insurance company. If your health insurance company determines that a particular service is not covered under your plan, your insurer will deny payment for that service.

It is your responsibility to know your insurance benefits. At the time you become a participating member of your insurance company, you are given access to a policy and identification card. Please review your policy and/or contact the customer service number on the back of your ID card and request the benefits department. We encourage you to confirm your benefits as we cannot guarantee coverage.