Insurance coverage varies for weight loss surgery procedures. It is crucial that you call your insurance provider to determine if your policy covers surgical weight loss. As an integral part of our team, a financial counselor can answer questions and give you guidance when working with your insurance company to acquire approval. It is a team effort between you and our financial counselor to ensure we do everything possible to gain an approval for surgical weight loss procedures such as laparoscopic gastric bypass surgery.
We understand the importance of surgical weight loss procedures and will work with you every step of the way. Should your insurance deny coverage, we will actively work with you to appeal the decision.
CCF has partnered with Bank of America to offer you an additional source for funds to help pay for elective surgical procedures or personal needs.
Click here to learn about Bank of America financing.
Cleveland Clinic accepts all major insurance carriers, including Medicare and Medicaid.
To contact our financial counselor about surgical weight loss procedures, call 216/445-1745 or 800/223-2273 ext 51745 or by email at cashd@ccf.org.
Gaining Approval
Most insurance companies will require extensive documentation regarding your attempts to lose weight in the past as they determine whether or not to finance your surgical weight loss procedure. To be prepared, we ask that you gather the following information:
- medical documentation of a five-year weight history
- any actual documentation of diet drugs and medically supervised diets prescribed
- any commercial diet program records (Weight Watchers, Jenny Craig, etc.)
- any exercise program records (YMCA/YWCA, gym membership, etc.).
You will need to begin gathering these records NOW so that these are available when we communicate with your insurance company. It is NOT enough for you to simply list these items on the initial patient worksheet questionnaire. The insurance company will require official documentation of attempts at weight loss.
If you have a weight history and weight treatment history at Cleveland Clinic, we will gather that weight information and weight loss drugs prescribed by Clinic doctors from your Cleveland Clinic medical record. For weight history outside Cleveland Clinic or its satellite offices, you will need to contact the doctor who weighed you and/or prescribed weight loss drugs for a copy of that documentation. A summary letter of dates, weights, medications prescribed and supervised diets from that doctor is acceptable. You may need to contact commercial diet program offices and exercise facilities for records if you do not have these.
Acquiring Approval
Once your test results, consults, weight history, diet and exercise program documentation and other records have been received and reviewed by our office, we will submit a letter of recommendation to your insurance carrier requesting approval for the weight loss surgery procedure. Your medical records are forwarded to your insurance company with this letter. The insurance company will let us know if there is any additional information they will need to make the decision to approve or deny your weight loss surgery.
Some insurance companies will make the decision about your weight loss surgery within a few weeks. Some insurance carriers take several weeks or months to return a decision. We will contact you when we have heard from your insurance company. You may contact your insurance company to check on the status of your insurance approval.
If your insurance company denies the request for coverage of your weight loss surgery procedure, our financial counselor will discuss appeals and self-pay options with you.
Bariatric COE Certifications
American Society for Bariatric Surgery: Center of Excellence
American College of Surgeons: American College of Surgeons, Level 1A Accredited Bariatric Center, Adult and Pediatric (15 years and above)
Anthem Blue Cross Blue Shield: Blue Distinction Program, Center of Excellence for Bariatric Services
Aetna: Aetna Preferred Bariatric Center Network
Medical Mutual of Ohio: Medical Mutual of Ohio Center of Excellence for Bariatric Surgery
Cigna: Center of Excellence Program for Bariatric Surgery
