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ANNOUNCEMENT - April 26, 2007 - Recently Oxford sent letters to patients indicating that we do not participate with them - -this is a MISTAKE -- We DO PARTICIPATE WITH Oxford. If you have any questions please contact our office at 212-263-3166.

Step 3: Determine How You Will Pay for the Surgery

If you are planning to pay out of pocket, proceed to Organize Your Medical Records.

If you are planning to have your surgery covered by insurance, you will need to complete the authorization process required by your insurance carrier.

We recognize that paying for surgery is difficult for many patients, especially for those without insurance or whose insurance carrier has denied coverage. Several payment plan options are available. The terms of each plan, whether it made through our office or through a financing company, is determined on an individual basis,

If your insurance carrier denies coverage, you may choose one of the following options:

  • Lump Sum Payment

  • Credit Cards

  • Loan from a Financial Institution

Insurance

Insurance coverage for morbid obesity surgery varies according to the insurance carrier, and those that cover bariatric surgery often limit their coverage to certain types of surgery. Many insurance carriers only cover gastric bypass surgery.

Insurance companies that cover morbid obesity surgery have varying requirements. Some may require medical records documenting co-morbidities (medical problems caused by your obesity) and/or records of medically supervised weight-loss programs. Many companies require at least six months of participation in a supervised weight-loss program within two years of your proposed surgery date.

Our office participates with several insurance plans. Whether we participate or not, our billing coordinator will work with you and your insurance carrier to obtain authorization for your surgery. Each insurance plan is unique, and obtaining authorization for surgery is often a long, labor-intensive process. Prior to your visit to our office:

  • Call your insurance carrier and make sure your plan provides coverage for weight loss surgery, and that you have covered benefits for morbid obesity surgery. However, policies change daily. Regardless of your insurance carrier, call to check your coverage. Keep in mind that although you may have completed all the necessary steps in order to schedule surgery, your insurance plan may not authorize it.

  • Obtain the name of the person you speak with (first name, last name, and direct phone number).

  • Your insurance carrier may request the name of the surgery and the CPT/ICD-9 codes. Insurance companies use the following codes to identify the type of procedure or surgery:

    • Lap Gastric Banding: 43770

    • Lap Gastric Bypass: 43644

    • Diagnosis Code (ICD-9) for Morbid Obesity: 278.01

  • Your call to the insurance company should be for informational purposes only. The surgery authorization process will be initiated by our office. You will receive your surgery date after you have met with the surgeon.

  • Our billing coordinator cannot initiate your surgery authorization process until you have a surgery date, even if you have already attended an information session and scheduled an appointment with the psychologist and nutritionist. If you initiate your surgery authorization process without having seen our surgeon, your insurance company may close your authorization case.

  • Once you have a scheduled surgery date, it may take another two weeks to two months to obtaining approval from your insurance carrier.

The NYU Program for Surgical Weight Loss participates in the following insurance plans:

  • Aetna

  • Cigna: On January 1, 2006 Cigna HealthCare designated the NYU Program for Surgical Weight Loss as a CIGNA Certified Hospital for Bariatric Surgery.

  • Empire Blue Cross/Blue Shield

  • Medicare

  • Healthnet/PHS - Designated as a participating Healthnet Bariatric Surgery Center of Excellence

  • PHCS

  • Oxford

  • UnitedHealthcare

  • HIP

 

Insurance Appeals

If your insurance company denies authorization for your surgery, and you decide to pursue an appeal for Lap-Band surgery, we suggest that you download these articles (a fee may be required) or photocopy them from a library, and include them with your appeal packet:

Step 4: Organize Your Medical Records