Frequently Asked Questions

To find out if your insurance covers bariatric surgery, we offer a FREE benefit verification service. Simply fill out this brief form: Bariatric Surgery Benefit Verification.
Once submitted, our team will review your insurance policy and provide you with information regarding your coverage for bariatric surgery. This can help you understand your financial responsibilities and options before moving forward with your treatment. 

• In-Network: In-network refers to insurance plans that our practice has contracted with. This means we have agreed to provide services at discounted rates for members of these plans, resulting in lower out-of-pocket costs for you. 
• Out-of-Network: Out-of-network refers to insurance plans that we do not have a contract with. In this case, we are not obligated to provide services at discounted rates, which may result in you being responsible for the full cost of your care.

When we verify your bariatric coverage, we will explain any estimated out-of-pocket expenses based on your specific plan.  

The amount you will need to pay depends on your specific insurance plan, and we will check this information on your behalf. You may be responsible for a copay, coinsurance, and/or deductible based on your coverage. 

We are committed to providing you with an excellent experience and the highest quality standards. To help you make informed healthcare decisions, we provide a good faith estimate of your likely out-of-pocket costs. 

This estimated patient responsibility letter is based on the most current coverage and benefit information verified by your insurance company. It outlines your insurance benefits and financial responsibility related to professional fees for BodyByBariatrics. 

Please note that this estimate covers professional fees only and is not a guarantee of the final amount due. You will receive separate financial information from the facility where your procedure will be performed, and we encourage you to contact them directly for additional details. If you have any questions about your estimate or insurance coverage, feel free to reach out to us by texting 407-543-0971. 

• Copay: A copay is a fixed amount you pay for a covered healthcare service, like a doctor’s visit or a prescription, at the time of service. For example, you might have a $20 copay for an office visit. 

• Coinsurance: Coinsurance is the percentage of the cost of a covered healthcare service that you are responsible for after you’ve met your deductible. For instance, if your coinsurance is 20%, you would pay 20% of the service cost, and your insurance would cover the other 80%. 

• Deductible: A deductible is the amount you need to pay out of pocket for covered healthcare services before your insurance starts to pay. For example, if your deductible is $1,000, you’ll need to pay that amount before your insurance begins covering a portion of your costs. 

These are important components of your overall healthcare costs, so it’s helpful to understand how they work together to affect your financial responsibility. We will send you a letter explaining any estimated out-of-pocket expense. Please text us with questions – 407-543-0971. 

The out-of-pocket maximum is the most you will have to pay for covered services during a plan year, including deductibles, co-pays, and coinsurance. Once you’ve reached this limit, your insurance will cover 100% of the costs for covered benefits for the rest of the plan year. It’s important to note that the out-of-pocket maximum only applies to services your insurance plan covers, and any costs for non-covered services, like those under an exclusion, would not count toward this limit. 

An exclusion is a specific service or procedure that your insurance policy does not cover. This means that even if a doctor deems the service medically necessary, your insurance company will not pay for it. For example, some insurance plans may have an exclusion for bariatric surgery, meaning they won’t cover any costs related to that procedure, regardless of your medical need. 

If your insurance has an exclusion, you may need to consider alternative payment options, such as self-pay or financing through CareCredit. 

In most cases, if your primary insurance has an exclusion for bariatric surgery or related services, your secondary insurance is unlikely to cover it as well. This is because secondary insurance typically follows the same guidelines as your primary insurance when it comes to exclusions. 

However, coverage varies by plan, so we recommend reviewing the specific terms of your secondary insurance or contacting them directly to confirm. If both plans exclude coverage, we’d be happy to discuss our self-pay options with you to ensure you still receive the care you need!

As a patient, it is your responsibility to ensure that your primary insurance is active and provides coverage for bariatric surgery. This includes verifying that your insurance plan includes bariatric services and understanding any requirements, such as prior authorizations or referrals. We recommend contacting your insurance provider directly to confirm your coverage details before proceeding with any surgical plans. This proactive approach will help prevent any unexpected out-of-pocket expenses and ensure a smoother process for your care.

Insurance can be challenging, and while your healthcare team may agree that bariatric surgery is medically necessary for you, an exclusion in your insurance plan often means that coverage is unlikely, even with strong medical support. Unfortunately, many plans explicitly exclude bariatric surgery, regardless of medical necessity. 

However, we’re here to help. We can assist you with navigating your insurance process and explore every possible option. If your insurance still doesn’t cover the surgery, we’d be happy to discuss our self-pay options and find a solution that works for you. 

Yes, if we are in-network with your insurance plan, it will typically cover your lifelong follow-up care. However, coverage may vary based on your specific plan, so we recommend checking your benefits for any potential co-pays or deductibles associated with these visits.