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Getting Started
Phone:
903.868.0133 opt. 2
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To
find out if your insurance covers Bariatric Surgery, make sure that
surgery and the treatment for obesity and weight loss are covered
benefits. Most importantly that they are not an exclusion to your
specific policy. Criteria for coverage vary from insurance company
to insurance company. You may need to provide them with the
following codes to determine if they are a covered benefit.
- Primary diagnosis is Morbid Obesity 278.01
- The CPT (procedure) code for the Lap Band© is 43770 (New Code)
If your insurance states that obesity surgery is excluded in your
policy, they will not cover anything. We would like to help you
with financing options.
If they say they will cover it, you will need to gather the
information listed below to send to us for the approval process with
your insurance company.
1. The patient information profile completely filled out.
2. Any letters or medical records from other health care providers
referring to weight related medical issues.
3. A recommendation for weight loss surgery from your primary care
physician
4. Any documentation proving you participated in any diet / weight
loss attempts. (This includes office notes, receipts or
prescriptions) Most insurance companies require proof that you have
tried for 5 years.
5. A copy of your insurance card. Back and Front please.
6. A copy of your Driver's License
7. If your insurance plan requires a referral for this
consultation, please contact your primary care physician to have one
faxed to this office before the appointment.
Please be aware the insurance company has 90 days to make a
decision. Once your paperwork is submitted we have no control on
how fast they deliver their decision. In many cases you will be
notified before we are by your insurance company. We can only use
approvals that are in writing.
Once we have an approval from your insurance company or you have
chosen a method of payment for the procedure, you will need to make
your appointment for your Pre-Op appointment.
Please call our main office number for that appointment.
903.868.0133 opt. 2
You may be required by your insurance to provide a co-pay.
The co-pay must be paid before your appointment.
ADDITIONAL EXPENSES: Like any other Outpatient Elective surgery, you
may have co-pay, deductible, or out-of-pocket expenses that you will
be required to pay.
Thank you for your interest in our Bariatric Program. For the
health and safety of our patients we follow the National Institute
of Health guidelines. The National Institute of Health guidlines
for Bariatric Surgery require a
Psychological Evaluation
and a
Nutrition Assessment.
A Psychologist's or Psychiatrist evaluation.
Most Insurance will pay for this evaluation. The psychiatrist’s
office will provide you with the necessary codes to get a referral
from your primary care physician if needed for those appointments.
This appointment can be scheduled through our office.
Vicky Borck DO
315 North Travis Street
Sherman, Texas 75090
(903) 893-1733
Diatetic Assessment.
Most diabetic assessments are done by a Wilson N. Jones dietitian
scheduled through our office. Insurance may or may not cover the
visit.
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