Insurance Issues & Financing

At Life Shape, we are committed to help you negotiate the complex process of obtaining insurance approval for your weight loss surgery.

Insurance Verification
To determine if your insurance policy covers obesity (or "bariatric") surgery, refer to the policy package that all insured people receive after they have paid their first premium, or received the policy package offered by their employer. Typically, there are two sections that describe the extent and limits of coverage. The first is usually called "What Is Covered" or "Covered Expenses." These are the healthcare benefits for which the company will pay. The other section is "What Is Not Covered" or "When the Plan Does Not Pay Benefits." In this section, the company tells the insured which treatments they have to pay for themselves. You should refer to your insurance information to determine whether your policy covers surgical therapy for the treatment of morbid obesity.

Some policies will outright exclude bariatric surgeries.

Medicare does cover weight loss surgery, but only at a limited number of "Medicare approved centers". LifeShape is not a medicare approved center and therefore we can not bill medicare.

For a listing of medicare approved centers follow this link:

LifeShape also can not accept Medicaid, Workmen's compensation, or any HMO with which we are not contracted.

Below is a partial list of companies that cover gastric banding surgery in Florida for at least some of their plans. (you should check your individual policy)
First Health
United
United Harris Corporation
Aetna
Cigna
Blue Cross
Tricare
Tricare Prime
Health First (Harris Employees)
Health First (Health First Employees)
Health First Medicare HMO

Patients who are able to obtain insurance approval will still be responsible for all copays and deductibles per their specific plan.

They also will be required to pay the LifeShape Program fee for non medical administrative costs associated with the program.

Submission Requirements
A Letter of Medical Necessity and weigh-loss history are necessary to obtain prior authorization for obesity surgery. A Letter of Medical Necessity states why significant weight loss is medically necessary for a patient and usually includes the following information:

• Patient's weight (which should be 100 pounds or more above ideal weight or a BMI more than 40 or more than 35 with associated medical problems to qualify)
  
• List of medical problems associated with obesity, such as type 2 diabetes, sleep apnea, hypertension, etc.
  
• Number of years patient has been overweight (which should be at least five or more)
  
• Number and types of failed weight-loss programs attempted in the past

If you create a document or packet listing all your weight-loss attempts (self-controlled or medically supervised) and their results, you can substantially increase your chances of getting insurance coverage for the LAP-BAND procedure. You should include any commercial diets or medical records of your weight-loss efforts. Contact us and we can assist you in preparing these documents.

Appeals
If weight loss surgery is specifically excluded from your insurance contract (see above) then there is little recourse other than changing insurance companies. This is a very risky maneuver because there is no guarantee that your new insurance company will cover your surgery. If weight loss surgery is not excluded by contract, but initial authorization is denied then each company has an appeals processes that can be initiated. There are a limited number of appeals, however, so this process should be undertaken with care. We recommend you consider enlisting the assistance of an attorney for your appeals. We recommend The Obesity Law & Advocacy Center.

The Obesity Law & Advocacy Center is a full-service private law firm devoted to representing morbidly obese persons in a variety of legal matters. The firm handles all types of civil litigation with an emphasis in appeal and grievance proceedings challenging the denial of medically necessary treatment for obesity and morbid obesity. They can be reached at www.obesitylaw.com

Self Funded option
Many patients do not have insurance coverage for bariatric surgery. To take advantage of the significant health benefits of weight loss surgery, many opt to self fund their surgery. To assist patients with this, we have arranged a package rate that includes all costs associated with the surgery, and all routine care for one year. This fee does not include the cost of potential complications. LifeShape does offer optional additional insurance coverage through the blis program for those that choose to participate in this program.

Patient Financing
Bariatric Surgery financing is available to patients who require funding for either part or all of the their surgery or program fees. Follow the listed links to begin the application process:

Blis/Chase financing: (will need provider number to apply #70656)

www.carecredit.com  

www.surgeryloans.com

Please contact our Financial Specialist Kathy Blair for assistance with self funding and financing.