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Bariatric Surgery Program Financial Review

The Bariatric Program (including bariatric surgery) is a proven method to help patients lose weight and improve overall health when other methods, such as diet, exercise, and lifestyle changes, have failed.  Within the MetroHealth System, we offer two types of bariatric weight loss surgeries: gastric sleeve surgery (CPT code 43775) and gastric bypass (CPT code 43644).  During the Program, you and your healthcare team will discuss the procedure best for you.  

INSURANCE – PATIENT OUT OF POCKET RESPONSIBILITY

While MetroHealth accepts many insurances, it is important to know whether your insurance is in network or not.  Your benefit plan may not cover certain services, and your out of pocket expenses may vary based on your plan.  Personal responsibility is based on your benefit plan and whether you have a co-pay, deductible, co-insurance or any limits of coverage.  Limits of coverage may be “lifetime limits” for any care received-whether or not just bariatrics and/or there may be a “Bariatric maximum limit” which means a cap or maximum insurance payment combined and allowed on all bariatric services including the surgery. 

For this reason, it is your responsibility and critical to notify the Financial Clearance Specialist at 216-957-2325 Option #3 of any change to your benefit plan, change of insurance company or change of employer/employment as you go through the Program.  The benefit plan and estimate could change, including your out of pocket expenses.

MHS’ Pre-Service Center can assist you with understanding how any of these changes impact your insurance coverage and personal out of pocket expenses.  It is your personal responsibility to update your insurance when making appointments.  Please contact the Pre-Service Center via email [email protected] or call 216-957-2325 Option #3 for questions about your coverage and/or an estimate of the expenses for which you will be personally responsible.  Your out of pocket responsibility is expected to be paid in full before the procedure date. 

PRIVATE PAY

We strive to make weight loss and weight management services accessible for everyone. We understand that insurance does not always cover metabolic and bariatric surgery and follow-up care, which is why we offer self-pay options to help make treatment available to you.

If it is determined that bariatric surgery is not a covered benefit under your insurance plan, or if you do not have insurance coverage, please contact MHS’ Pre-Service Center at 216-957-2325 Option #3 so that we can discuss alternative payment options.  A no interest pre-surgical payment plan can be set up to assist you with paying your out of pocket responsibility prior to the surgery.

Please note, Bariatric Surgery is not eligible under the financial assistance or discount program because it is considered a weight loss program of choice in lieu of other weight loss alternatives.

PRE-PAYMENT PLAN: A no interest pre-surgical payment plan can be set-up to assist you with paying your out of pocket responsibility prior to the procedure.  This will be further discussed when you receive your Patient Out of Pocket Responsibility, or if you are Private Pay.

AUTHORIZATION REQUIREMENTS

Most insurance plans require prior authorization before you can have your procedure.  Our Financial Clearance Specialist will help identify whether an authorization is required by your benefit plan.  The supporting clinical documentation will be submitted as required to procure approval.  If you did not provide your updated insurance, we will not be able to get the necessary approval.   Please make sure when you are having services you update and confirm accuracy each time.  If there are challenges with the approval process, our team will advocate for you to assist with pursuing approval for the weight-loss procedure.

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