Questions to ask your insurance carrier
- Do I have a benefit for weight loss surgery?
- If "Yes"...your insurance carrier provides coverage. If your insurance carrier covers weight loss surgery, ask them what procedures they will cover and what the criteria is for using your benefit. Use this information to determine whether you qualify for coverage. Some carriers will tell you this information can only be given to the medical provider, your doctor. This is incorrect. As a premium-paying policyholder, you have a legal right to know what is required to utilize your benefits. Make sure to document the name and extension of the person you discussed the coverage limits with.
- If "No"...Your Insurance Carrier Does Not Provide Coverage In this case, if you want the procedure, you will need to consider patient financing or paying cash as other options.
- What Type of Plan Do I Have: PPO or HMO?
Whether or not you have a PPO or HMO plan is important because it determines the surgeon and hospital your insurance plan authorizes. In general, PPO plans allow you much more flexibility in choosing your physician and program.
- PPO Plans - Ask If Your Policy Provides Out-of-Network Benefits PPO plans generally have out-of-network benefits that allow patients to select their physician of choice. Benefits are slightly reduced when choosing an out-of-network doctor, which will result in some out-of-pocket expenses for the patient. Your specific plan will determine what out-of-pocket expenses you will be responsible for.
- HMO Plans HMO plans generally do not allow members to obtain surgery outside of the network. They may generate a referral for a consultation but will not provide a referral for surgery.
Need Help with Insurance Information?
Our staff will help guide you through verifying coverage. Please contact us at (928) 336-LITE (5483).