| FAQs: 3. Insurance |
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Please note - this is NOT medical advice. Below are questions typically asked by people considering weight loss surgery, followed by some comments from our surgeons. These comments are for educational purposes only. For medical advice, be sure to consult a bariatric specialist in person regarding your unique situation.
If you can't find the answers you need here, just ask us.
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| How does the scheduling process work? |
| Once we have received written authorization from your insurance company, we will look at what is available on our schedule and provide you with an appointment. We will then order all of your pre-operative testing at Theda Clark, unless you have indicated that you would prefer your pre-op work-up to be done at your local hospital. |
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| How long does it take for my insurance company to respond? |
| When we send in your request for pre-authorization to your insurance we will also send you a copy of the letter. Your insurance company will take anywhere from one to over six weeks depending on their review process. It is in your best interest to contact them regarding your status in the review process. |
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| How much does this procedure cost? |
| We have very competitive pricing for the weight loss surgery procedures, typically well below the national average of $35,000 to $70,000 per surgery. Please contact our office to discuss your individual situation in more detail. |
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| Is there a cash option available to patients who do not have insurance to cover the procedure? |
| Yes. |
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| What are my options if my insurance doesn’t cover this procedure? |
| If this is a benefit under your policy and your insurance company deems this “not medically necessary,” you can appeal through the state of Wisconsin’s Insurance Commissioner’s Office. The cost for this is $25 and the state will provide you with an independent review conducted by a surgeon who performs this same procedure in another state. If this review finds that you have met the requirements stating that this procedure is a medical necessity for you, your insurance company will be required to uphold that ruling and your $25 fee will be returned to you. If the surgeon agrees that medical necessity requirements have not been met, your insurance company’s ruling will hold and you will lose your $25 fee. |
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| When will you send my letter of authorization? |
| At the seminar you would have received a form that indicated what testing you would need prior to our office sending in your pre-authorization letter to your insurance. This would have included a psychological or psychiatric evaluation, possibly a sleep apnea test and an echocardiogram. Once we receive all of your information, we will issue a letter of pre-authorization request to your insurance. |
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