Weight loss surgery is covered by Blue Cross Blue Shield of Mississippi, however it must be included in your specific insurance for it to be covered.
A list of Blue Cross Blue Shield of Mississippi plan types and whether or not they cover bariatric surgery is shown below:
Will Medicaid pay for gastric sleeve in Mississippi?
Mississippi Medicaid enrolled health-care providers should be aware that bariatric surgery is currently not covered by the program.
Does Blue Cross Blue Shield MS cover weight loss surgery?
Obese people frequently question whether Blue Cross Blue Shield will support weight loss surgery. The answer is yes, but only if you meet your insurance provider’s specific eligibility requirements. Obesity and its related co-morbidities can be effectively treated with bariatric surgery. You can get Blue Cross Blue Shield bariatric surgery coverage if you can prove that your treatment is medically necessary.
How much is gastric sleeve surgery in MS?
The cost of a Gastric Sleeve (inpatient) in Mississippi is $14,090 according to MDsave. Those with high deductible health plans or those who are uninsured can shop, compare costs, and save money.
What if your insurance doesn’t cover bariatric surgery?
After you’ve weighed your alternatives and decided that bariatric surgery is the best option for you, you’ll want to know how you’ll pay for it. Many insurance companies acknowledge the importance of obesity and its health repercussions, and will pay for weight loss procedures if you meet plan-specific eligibility requirements.
How to verify your own benefits
Although the staff at your surgeon’s office will verify your benefits as a courtesy, it’s a good idea to call your insurance carrier to confirm coverage and restrictions. You can also read the coverage documentation that your employer and/or insurance company have issued to you.
You’ll want to know if bariatric surgery is covered; if it isn’t, it’ll most likely be included under “obesity” or “weight reduction surgery” in the plan’s exclusions. Bariatric surgery is commonly described as being covered if it is medically required, but this is only partially accurate because it must also be a covered benefit.
You’ll want to know what’s required once you’ve confirmed that your plan covers bariatric surgery. Each plan has its own set of criteria and regulations for determining medical necessity to your insurance carrier’s satisfaction. Although your carrier’s medical policy is the most typical place to obtain benefit criteria, your employer may have an addendum document (“summary plan document/description”) that explains extra or other requirements for particular treatments. Because the requirements of the medical policy are often superseded by a summary plan document, it’s crucial to know if an addition like this applies.
Medical necessity vs. coverage exclusions
Despite the fact that you may meet basic and widely accepted medical necessity requirements, your insurance company is not compelled to cover bariatric surgery. Your insurance will not consider you for coverage if weight loss surgical services are designated as an exclusion, regardless of your BMI or concomitant conditions. The denial rationale does not imply that surgery is not medically required, but rather that they do not give this form of coverage, for which there is no appeals process.
Cash paying for surgery
There are alternative solutions open to you if your insurance does not cover bariatric surgery. Consultations, nutritional counseling, pre- and post-operative tests, labs, and follow-up visits may be covered depending on the plan language, but surgery is not. Verifying your benefits will assist us in estimating potential costs for you during your appointment.
How to meet insurance criteria
You’ll meet with a surgeon for a consultation once your benefits have been validated. Your height, weight, and BMI will be recorded, as well as any concomitant conditions and previous unsuccessful attempts at non-surgical weight loss. If your plan calls for a medically supervised weight loss program, you’ll meet with a nutritionist on a monthly basis for the duration of your treatment.
Because a psychological clearance is the most prevalent insurance criterion, you should make an appointment with a mental health specialist who will assess your candidacy for bariatric surgery. It’s crucial to rule out psychological issues, any type of disordered eating, a lack of competence to provide informed consent, and a failure to follow pre- and post-surgical instructions.
Insurance authorization process
The authorisation process can commence if all pre-surgical and insurance requirements have been satisfied. Your pertinent medical records will be compiled and sent to the clinical review department of your insurance company. A determination can take up to four weeks, but it is more common to receive one in two weeks. You’ll be advised of the approval or denial once we hear from your insurer. Surgery can be planned or confirmed once you’ve gotten approval.
If your operation is denied, we will examine the decision and follow the measures provided by your insurance company. Denials can occur for a variety of reasons, including a lack of paperwork or a lack of agreement on criteria that are ambiguous or open to interpretation.
Appeals
Because appeals deadlines may be approaching quickly, it’s critical to properly evaluate denials.
As a first step in this procedure, a peer-to-peer option is usually provided. A peer-to-peer meeting is a prearranged meeting between your surgeon and the medical director of the insurance company to address the denial. When this conference is feasible, it’s quite beneficial since we can get precise input from a reviewing authority about what additional the insurance company expects us to provide or what they want you to accomplish in order to qualify. At the time of this debate, the rejection may be affirmed or reversed, but it’s usually just a tool for moving forward with the appeal.
If an appeal is necessary, we will obtain any additional documentation that was previously overlooked. If more tests or office visits are needed, they should be planned as quickly as possible to ensure that they are completed before the appeal time expires.
There could be several stages to the appeals process. A second- or third-level appeal can be requested if necessary, with the final step typically including submission to an outside party for review. Because external review organizations are not linked with our office or your insurance provider, they can conduct an unbiased assessment of your clinical documentation.
What can I do to ensure approval?
A patient health history questionnaire will be given to you prior to your session. Because it will be translated into your medical record, which will be evaluated by the insurance provider, it is critical that you fill this out entirely and truthfully.
Bring a copy of any paperwork (medical chart notes, personal records, logs, or receipts) from past weight loss attempts, whether by diet, exercise, or medical supervision, to be reviewed and scanned into your chart.
If you’ve had a previous weight reduction treatment, you should get copies of your operative report, as well as pre- and post-surgical visits, to demonstrate your commitment to follow-up and adherence to any suggestions provided by your previous practitioner.
The single most important thing a patient can do to increase the chances of their insurance company approving their claim is to follow the medical policy’s rules to the letter (or Summary Plan Document, if applicable). Medically supervised diets are generally need to be followed for several months and should be spread out by about 30 days. Failure to keep scheduled appointments for several months in a row will almost always result in denial, delaying surgery or forcing you to restart the prescribed regimen from the beginning.
How do you qualify for the gastric sleeve?
The following are the minimum prerequisites for gastric sleeve surgery:
- A BMI of 30 to 39.9 combined with a major obesity-related health issue such as diabetes, high blood pressure, sleep apnea, high cholesterol, joint difficulties, and so on.
How much does weight loss surgery cost?
If you don’t have insurance, weight loss surgery might cost anywhere from $15,000 to $25,000. With private health insurance, you may usually minimize your costs in half, as your insurer will cover your lodging, theatre fees, anesthetic, and certain doctor’s fees. The following are some of the medical professionals who offer weight loss surgery.
How do you pay for gastric sleeve?
The cost of weight-loss surgery is determined by a variety of factors, including your location, the hospital you choose, the surgeon’s fees, and the method you choose. According to Obesity Coverage, a bariatric surgery information site, lap-band surgery costs $14,500 on average, whereas gastric bypass surgery costs $23,000 on average.
It’s natural if the price tag makes you gag; after all, it’s more than some new cars cost. It may, however, be well worth the cost. According to the American Society for Metabolic and Bariatric Surgery, weight-loss surgery can help you avoid significant health problems and live longer.
Because of what it may accomplish for your health and happiness, bariatric surgery is one of the rare times when going into debt is a positive choice. Fortunately, there are six different payment options to choose from to make the expense more bearable.
Secured medical loan
A secured medical loan, according to Bariatric Surgery Form, is a typical source of funding. A secured medical loan is one that you back up with assets such as your home or car.
You may be able to borrow up to the whole cost of the treatment, depending on the value of your collateral. Because the loan must be secured with collateral, you may be eligible for lower interest rates than you would with other forms of loans. Furthermore, you normally have up to ten years to repay the debt.
Make sure you can afford a loan before applying for one. If you default on your payments, the lender has the right to confiscate your assets.
Hospital payment plan
You may be eligible for a payment plan depending on the hospital you choose for your operation. Some hospitals will let you spread the expense of surgery over a period of months or even years, with low interest rates. Contact your hospital’s billing department to see if payment options are available.
(k) loan
Although taking money from your retirement account isn’t ideal, there are times when it’s necessary, such as for medical procedures. Taking out a retirement plan loan can help you attain your goals if you’re considering bariatric surgery.
You are borrowing money from yourself when you take out a 401(k) loan. You take out the desired amount and then make interest-bearing monthly installments on the loan. You can normally borrow up to $50,000 or 50% of your vested account amount, whichever is smaller, with a 401(k) loan. You may also be required to pay set-up and maintenance costs.
Before taking out a 401(k) loan, there are certain drawbacks to consider. You lose out on account growth while the loan is being repaid, which might cost you thousands of dollars over time. If you lose your work or are laid off, you have until the due date on your federal tax return to repay the loan; otherwise, you will be responsible for paying taxes and penalties on the amount borrowed.
CareCredit
CareCredit is a credit card that can only be used for medical costs that meet certain criteria. You won’t pay interest if you pay off the loan in full within the promotional period if you can afford a repayment term of 24 months or less.
However, before using CareCredit, make sure to read the tiny print. If you don’t pay off the debt during the promotional period, CareCredit will charge you interest from the initial purchase date, so you won’t be able to take advantage of the 0% interest offer.
You can choose a payback period of up to 60 months, but the interest rate will be comparable to that of other credit cards.
Health savings account
If you have health insurance with a high deductible, you may be eligible for a health savings account (HSA). An HSA is similar to a personal savings account, except that the funds can only be used for medical expenses, such as bariatric surgery. If you’re single, you can contribute up to $3,450 per year to an HSA as of 2018.
A health savings account (HSA) may be a more cost-effective option than a personal savings account. HSA contributions are deducted from your pretax wages, reducing your taxable income. Furthermore, any interest earned on the account is tax-free, and any withdrawals made for qualified expenses are also tax-free.
If you don’t utilize the money in your HSA, it rolls over to the next year, unlike a flexible spending account. As a result, an HSA can be a good method to save money and pay for surgery.
Personal loan
If you have decent credit, a low-interest personal loan could be an excellent choice. Personal loans, unlike secured medical loans, usually do not require collateral, so you won’t have to put your home or other belongings at risk.
You can borrow anywhere from $1,000 to $100,000 and have up to seven years to repay it, depending on your credit history and salary. A personal loan might be a cost-effective option for moving forward with your weight-loss operation provided you qualify for a low interest rate.
However, you should only apply for a personal loan if you have excellent credit. Otherwise, you risk paying interest rates as high as 35.00 percent, which could add thousands to the cost of the procedure.
Assume you borrowed $23,000 to pay for gastric bypass surgery and were approved for a five-year loan with a 5.00 percent interest rate. You’d repay $26,042 throughout the length of your payback period. In comparison, if you borrowed $23,000 and were approved for a five-year loan at 35.00 percent interest, you’d owe $48,977. You’d end up spending more than double the cost of surgery due to interest costs.
If you decide to proceed, compare personal loan lenders’ offers to guarantee you obtain the best rates.
What is the difference between gastric bypass and gastric sleeve?
Working with your doctor to determine the best weight loss technique for you is recommended.
- On average, gastric bypass patients lose 50 to 80 percent of their excess body weight in 12 to 18 months.
- Patients who have a gastric sleeve lose 60 to 70 percent of their excess body weight in 12 to 18 months on average.
- Gastric bypass surgery is usually suggested for individuals who are extremely obese, with a BMI of 45 or more.
Learn more about our surgical choices and compare the differences between the various bariatric surgery treatments available at UPMC Bariatric Services.
Does Medicaid cover gastric sleeve?
Lap-Band Surgery, gastric sleeve surgery, and gastric bypass are all covered by Medicaid in most circumstances. These are not just easily funded by Medicaid, but they are also among the most frequently recommended operations. In some cases, these are deemed medically necessary for the patient’s survival and well-being.
Gastric bypass surgery reduces the size of the stomach while also bypassing a portion of the intestine. As a result, you eat less and the food is delivered directly to the lower intestine. Nutrient and calorie absorption is reduced as a result of the bypass. As a result, it limits food intake while also assisting in weight loss. The top region of the stomach is covered with silicone bands and balloons in Lap-Band surgery. This limits the amount of space available for food storage. In addition, the stomach’s entrance narrows. The technique is less invasive than others because it is performed laparoscopically. It is also desirable because it is simple to reverse and the band can be changed. Finally, a sleeve-shaped, smaller stomach is constructed through gastric sleeve surgery. Because there isn’t much room for food to sit, it passes through the intestines quickly. As a result, it also reduces food intake and calorie absorption.
How much is bariatric surgery out of pocket?
The cost of bariatric surgery can range from $15,000 to $23,000. The majority of people who have bariatric surgery are able to do so because it is a covered benefit under their health insurance plan. Our insurance consultant will meet with you on your first visit to our bariatric program. Their job is to explain your coverage and any potential out-of-pocket expenses. There are a few other things to keep in mind about your insurance and bariatric surgery: