Oregon Bariatric Center
 

Answers to Your Insurance Questions

Undoubtedly, you have many questions about insurance coverage for medical and/or surgical bariatrics.

As a general rule, the declared policy of most insurance companies is that bariatrics is not covered. However, in February 2006, the Centers for Medicare and Medicaid Services (CMS) announced expanded coverage of surgical bariatrics for Medicare recipients. Also, with increasing pressure from patients, it is occurring more often that insurance companies will review requests for surgical bariatrics coverage on a case-by-case basis.

Before coming to the Oregon Bariatric Center for your first visit, we strongly encourage you to contact your specific insurance company to determine whether your benefit plan covers bariatric services. 

You must be a strong advocate when working with your insurance company. Don’t be discouraged just because bariatrics is not covered initially. With your active involvement, a change to your policy is possible, as has been proven with bariatric patients across the country.

For a detailed explanation of the process that insurance companies undertake in reviewing surgical bariatric cases, visit Bariatric Edge. A video version is available here. (click “Hear healthcare PROFESSIONALS… and then click on the Financial Expert image)

Coverage may be subject to meeting specific medical criteria. This includes BMI requirements and co-morbidities. Also, coverage may be limited to specific procedures, such as open and laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding.

Typically, medical bariatrics (the non-surgical program) is not a covered expense.

Insurance coverage for weight loss procedures is a complex subject. Our financial specialist and patient access specialist will try to answer as many of your insurance questions as possible. Given the evolving nature of insurance coverage, you should review your specific insurance policy and consult with a representative from your insurance provider.

Self-Pay
Some patients may elect to pay for surgical weight loss on their own. If you are considering this option, some of the services that the surgical program comprises are:

  • Surgeon’s surgical fee

  • Surgical assistant fee

  • Hospital’s surgical fee

  • Anesthesiologist fee

  • Pre-op labs and exams to qualify for surgery

  • Psychologist fee for psychological evaluation

  • Post-op visits

  • LAP-BAND fills (if applicable)

  • Nutritional counseling by a registered dietitian

Weight Loss Program Expenses Tax Deductible
In 2002, the Internal Revenue Service stated that “obesity is medically accepted to be a disease in its own right.” This means that certain expenses paid out of pocket may be tax deductible as long as you itemize your tax return. Also, your dental and medical expenses can only be deducted if they exceed 7.5% of your adjusted gross income for that year. There are other conditions that apply to this law, so consult with a tax advisor for complete details.


Additional Insurance Resources
We’ve provided a few links here to assist you with locating information.

Center for Medicare and Medicaid Services
http://www.cms.hhs.gov.

Health Net
www.healthnet.com 

Lifewise
www.lifewiseor.com 

ODS Health Plan
www.odscompanies.com 

Providence EPO
http://www.providence.org/health_plans 

Providence Medicare Extra
www.providence.org/health_plans/default.htm 

PacifiCare
www.pacificare.com 

PacificSource
www.pacificsource.com 

Regence BlueCrossBlueShield of Oregon
www.regence.com

 

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