Will my insurance cover the cost of my weight loss procedure?

Liz and Lyndsey are experts in dealing with insurance providers and will go the extra mile to get your surgery approved. We promise we won’t let a co-pay stand between you and your health as we will work with you to set a payment plan that will fit your budget. There are no upfront or non-refundable “program fees” required in order to submit your insurance for approval.

Most major health plans provide coverage for the adjustable gastric band. As a general rule, the insurance companies will assess your candidacy using the FDA recommended guidelines of a BMI of 35 with two co-morbidities or a BMI greater than 40 with no co-morbidities. However many health plans specifically exclude bariatric treatments. Others will approve surgical treatment only after you have attempted a non-surgical weight loss program.

Some insurance companies now cover the Gastric Sleeve procedure. This number is small but growing. Most Gastric Sleeve procedures will require the patient to self pay. However, let us contact your insurance provider and work for you to get your surgery approved.

TLCEdge will be glad to assist in determining if your plan covers surgery and what prerequisites may be required. Please call one of our Care Coordinators to begin the approval process. The Care Coordinator will ask you for your weight loss history and take down your insurance information so they can begin the certification process. If it is determined that your benefits require a period of non-surgical weight loss program, TLCEdge Medical Weight Loss will work with you to accomplish this requirement.

You may wish to contact your insurance company to inquire about benefits prior to contacting us at TLCEdge Surgical Weight Loss. You will need to call the customer service number indicated on the back of your insurance card and ask the following questions:

1. Is the Surgical Treatment for Morbid Obesity a covered benefit?
   Your insurance company will ask you for a "procedure code" or "CPT code" for the Gastric Banding Procedure. This CPT or Procedure Code is 43770. Your insurance company will ask you for a primary diagnosis. The primary diagnosis is Morbid Obesity 278.01

2. Are there any exclusions for the surgical treatment for morbid obesity on your policy?

If your insurance company indicates that the procedure is a covered benefit or if they indicate that the procedure is a covered benefit if "medically necessary" we will help you get started on your insurance file at once. This is a specialized process and will require you to work with our Care Coordinators to provide various documents including copies of insurance cards, driver's license, documentation regarding previous participation in diet and weight loss programs and any required letters of referral or medical necessity.

We are expert in dealing with insurance and will go the extra mile to help you get your surgery approved by your insurance carrier. If there are prerequisites in your plan, TLCEdge is the only program in North Texas with a full spectrum of non-surgical treatments and a team of experienced bariatricians, dieticians and nutritionists to help you meet your insurance company requirements.

Don't be discouraged if your plan excludes bariatric surgery, with TLCEdge's competitive discounted cash plan, you may be able to finance your surgery easier than you think.