Will my insurance cover the cost of my weight loss procedure?
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Vicki, Director of Insurance |
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Christy, Case Manager |
Most major health plans provide coverage for bariatric surgery. 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. It is very important for us to have a full medical history of all your co-morbidities when we submit your insurance request. This will speed the approval process. Be sure and tell your Case Manager about all your health issues, not just overweight.
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TLCEdge will be glad to assist in determining if your plan covers surgery and what prerequisites may be required. Let us contact your insurance provider and work for you to get your surgery approved. Please call one of our Care Coordinators to begin the approval process. If it is determined that your benefits require a non-surgical weight loss program, TLCEdge Medical Weight Loss will work with you to fullfill this requirement. |
Shireen, Case Manager |
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You may wish to contact your insurance company on your own 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:
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 Case Manager 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.
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