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Your health insurance paves the way for your weight-loss journey. Bariatric surgery is an elective procedure, so it is important you understand what is and is not covered by your insurance plan. Our insurance coordinator can help explain your pre-approval requirements and submit you for coverage. Most insurance plans require you to participate in a weight-loss trial under a doctor’s supervision. They may also request documents that show that your weight has been a long-term health issue.
Insurance FAQs
I don't know if I have bariatric benefits. How can I find out?
Your insurance company will be contacted by one of our specialists for verification. Then, we will contact you to help you understand your benefits. Prior to surgery, our Patient Advocate will provide you with a customized checklist that includes your insurance requirements.
My insurance doesn't cover bariatric surgery. What are my options?
Your patient account can be designated as “self-pay” for bariatric services. You will be given information about bundled and discounted self-pay fees. Financing is also available.
I am self-pay for surgery. When do I pay the surgery fee?
Payment is due in full at your pre-operative appointment, approximately two weeks prior to surgery.
What forms of payment do you accept for self-pay surgery?
We accept credit cards and cashier’s checks. Please contact our front desk at 615-396-4965 for specific details.
I have bariatric coverage, who will submit my claim to insurance?
Ascension Saint Thomas Rutherford Bariatric Center will submit your claims to your insurance company if you have bariatric benefits. Claims may be covered, denied or partially covered by your insurance company.
Will I receive a bill if I have bariatric benefits?
You may receive a bill for your share of the financial responsibility. This can be due to an insurance deductible, an amount not covered by your plan, or a percentage shared between you and your insurance company.
Will I have a co-pay?
A specialist’s co-pay may be required by your insurance company at the time of your visit. There are no co-pays for self-pay patients. However, a fee for services rendered may be due at the time of your visit.
I received a predetermination of benefits, will I receive a bill?
A predetermination of benefits does not guarantee payment of services by your insurance company.
Do I need a pre-authorization for surgery?
It depends on your insurance plan which your insurance specialist will verify. Your insurance specialist is also responsible for submitting the pre-authorization request for surgery and obtaining it on your behalf. You are responsible for following the program steps the Patient Advocate has laid out for you. You must also provide the required documentation to the insurance specialist. This may include a letter of medical necessity from your primary care doctor.
Do I need a referral for my first bariatric appointment?
If you have an HMO, you will need a referral from a doctor. Otherwise, it depends on your insurance plan. Your insurance specialist will verify before your appointment.
