Determining cost—and your level of insurance coverage—is a critical part of the weight loss surgery decision making process.
Below are some guidelines that can help you move forward. It is important that you determine a payment plan before formally enrolling in any weight loss surgery program. We will do our best to support you in this process.
Medicare covers all medically necessary weight loss surgeries at Centers of Excellence. Middlesex Health is designated as a Center of Excellence.
Please note: Medicare does not give prior approval for surgery, so denial is still possible before or after your procedure.
Private insurers vary in their coverage of bariatric surgery—even within the same insurance company, coverage can be different between policies. Gastric bypass and sleeve gastrectomy are covered in many plans, and certain insurers now cover bariatric surgery at a lower BMI (BMI >30) for patients who also have type 2 diabetes.
It is important to review your own policy to determine if your benefits include the procedures offered by Middlesex Health.
Financial counseling and pre-authorization from your insurance company must occur before a surgery can be performed.
Some patients choose to pay for surgery on a self-pay basis. You can arrange for this by speaking directly to your surgeon's office.
The self-pay packages available at Middlesex Health include provisions that protect you from financial issues that arise up to two years after surgery, in case of any rare complications.
If your insurance company denies coverage of a weight loss procedure, do not consider this a "definite no." Insurance applications and appeals are handled directly by our knowledgeable and experienced staff, who can provide additional information to the insurance company. In many cases, submitting a formal appeal will result in a denial being overturned.
If your insurance carrier remains unreasonable, you can consider writing to your legislator or seeking legal assistance. Our team will provide you with counseling and support, should this matter arise.