Center for Obesity and Metabolic Surgery

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Insurance Information

The Center for Obesity and Metabolic Surgery team does everything necessary to ensure proper insurance information is listed on a patient's account and benefits are properly coordinated. Some of the services provided may be considered “non-covered” or “exclusions” to your insurance policy. We will make every attempt to notify you promptly before the services are rendered. The financial counselor informs the patient about the financial impact of treatment. Before treatment begins, we will make a good faith attempt to provide the patient with an accurate estimate of treatment costs that may not be covered by the patient's insurance.

Financial counseling services are provided to our patients here in our clinic. The financial counselor is responsible for assisting all patients, staff, and physicians with needs related to insurance.

Every patient that is a candidate for surgery will receive a consultation. During this period, the financial counselor will meet with the patient one on one to discuss payment options. All patients are encouraged to contact their insurance companies to obtain information.

The information that is provided to each patient is only an estimation of benefits and not a guarantee of payment. The benefits obtained from the insurance company are based on the level of coverage during the time of verification. Please be mindful that your insurance coverage can change without notice.

Patients that are seeking bariatric surgery must have an identified financial source such as insurance or other means to cover the cost of care. It is ultimately the patient’s responsibility to know their insurance coverage and limitations. This is why we encourage every patient to call their insurance carrier for coverage determinations.

Attention adjustable gastric band patients
Most insurance companies cover the adjustable gastric band procedure and not the actual adjustable gastric band adjustments. Please verify with your carrier what the guidelines are for coverage.

Insurance Requirements
Here is a list of general guidelines for coverage of bariatric surgery as defined by some of the major insurance carriers. These are only general guidelines that may or may not apply to your particular medical insurance coverage. Most insurance companies have requirements that must be satisfied which will include the following:

Minimum age of 18 or documentation of completion of bone growth

Body mass index (BMI)* exceeding 40 OR

BMI* greater than 35 in conjunction with one or more severe co-morbidities which can include:
  • Coronary heart disease
  • Type 2 diabetes mellitus
  • Obstructive sleep apnea
  • Hypertension (BP> 140 mmHg systolic and /or 90 mmHg diastolic)
    *Other medical conditions not listed above may also qualify you for coverage, please call your provider for details.
History and physical with documented three to five year history of morbid obesity

Documentation of medically supervised non-surgical methods of weight reduction by an MD, DO or nurse practitioner – that includes nutritional, medication and/or maintenance therapy, behavior modification, exercise or increase of activity.

*Depending on your insurance, supporting documentation will have to be provided that outlines your participation in a treatment plan for a defined period of time. (i.e. Cigna, Blue Cross and Blue Shield, and some Great West Healthcare plans require 6 months of conservative treatment whereas most Aetna and American National insurance plans only require 4 months of consecutive non-surgical treatment).

Psychological evaluation by a licensed mental healthcare professional that addresses the following:

  • Absence of problems related to alcohol or substance abuse.
  • Absence of major psychotic or disabling mental health diagnosis
  • Absence of compulsive or obsessive-compulsive disorder.
  • Eating disorders (i.e. bulimia)

Documentation of willingness to comply with preoperative and postoperative treatment plans.

Once your insurance requirements have been satisfied, your documentation will be reviewed again to make sure that all diagnostic test and lab work have been completed. The surgeon will give the clearance to proceed with predetermination. The predetermination process can take anywhere from a few days up to several weeks depending on your insurance provider. Please feel free to contact your insurance company to check the status of your request.

Call for assistance day or night 409-772-2222

Great Location.
Excellent Results.

We are a MBSAQIP Accredited - Comprehensive Center as designated by the American College of Surgeon’s Bariatric Surgery Center Network Accreditation Program. Please explore our site to learn more...

2660 Gulf Freeway South
Suite 3
League City, TX 77573

Phone: 832-505-1500
Fax: 281-614-0686

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