Each insurance company requires different specific documentation to be met for approval of Bariatric Surgical procedures. Our insurance coordinator will work with you and your insurance company to make this process as easy as possible. The Medical Center of Plano accepts most insurance plans.
The following requirements outlined are only a general list of what your health plan may require.
- At least a 5 year history of morbid obesity supported and documented by physician medical records. Dr. Patel will contact your primary care physician and provide the necessary forms for your physician to fill out.
- BMI≥ 40 or BMI ≥ 35 with at least one or two co-morbidities (health problems such as Diabetes, High Blood Pressure, or Sleep Apnea, etc.).
- Recent history and physical exam by your primary care physician (PCP).
- Psychological evaluation and screening – the purpose of this evaluation is to determine your motivation and commitment to make the required lifestyle and behavioral changes that accompany weight loss surgery. In addition, we want to assess your emotional preparedness and intellectual ability to follow the necessary guidelines that will result in the transformation of all aspects of your life into a “new you”.
- Some insurance plans may require a 3, 4 or 6 months participation in medically supervised weight loss program prior to approval. This may be accomplished in several ways depending on your insurance specifications:
- Physician supervised nutrition and exercise program – generally performed through your PCPs office. Dr. Patel will contact your physician and provide the doctor with the appropriate forms and documentation requirements.
- Multidisciplinary surgical preparatory program – performed at our center. This includes nutritional therapy by a dietician, psychological evaluation with behavioral modification counseling, instruction on exercise and increase physical activity to lose fat and maintain muscle mass and tone, and continued support to maintain the ongoing lifestyle changes that will reduce health risk factors and improve overall quality of life. Even if you complete this program, it is essential that you follow up with your PCP long term. This is mandatory.
- Some insurance plans only require a clinically supervised program of weight reduction attempts such as a Weight Watchers or Jenny Craig type of program. It is important to have certificates and/or receipts from these programs for documentation to satisfy the insurance companies.
- If you proceed with a medically supervised weight loss program thru through your PCP, Dr. Patel will contact your physician and provide the doctor with the appropriate forms and documentation requirements.
- Please note – most likely, the initial weight and BMI at the beginning of a weight reduction program will be the “qualifying” BMI used to meet the BMI criteria for the definition of morbid obesity.
- A letter of medical necessity will be written and submitted to your health insurance provider to obtain authorization for surgery. Approval may take up to 1 to 2 months or longer.
If you do not have insurance, or your insurance does not cover Bariatric Surgery, we do offer a self-pay option. We have discounted pricing packages which includes fees associated with our complete Bariatric Surgical Program. The Program price includes:
Bariatric Wellness Program
- 6 hour Nutrition, Emotional and Physical Wellness Course
- Psychological Evaluation
- Regular scheduled post-op visits with Registered Dietitian (RD) for one year
- As needed post-op visits with Licensed Professional Counselor (LPC) for one year
- As needed phone, e-mail and short consultations with both RD and LPC for one year
- Pre-op testing to include: Labs, Chest Xray, EKG, Upper GI, Ultrasound of Abdomen
- All routine hospital charges for up to 3 nights (One night for Adjustable Gastric Banding patients) in hospital. A fee will be charged for any additional nights in hospital.
- Post-op testing to include: Upper GI and PVD screening
Surgical Professional Fees
- Assistant Surgeon
Comprehensive Pre- and post-operative visits with Dr. Patel for one year.
- 3 band adjustments (for Adjustable Gastric Banding patients) with Fluoroscopic Guidance by Dr. Patel.
Please contact our office, at 972-519-1552, if you would like more information on our self-pay options.