Weight-Loss Surgery: Maximize Your Deductible in 2019


Weight-Loss Surgery: Maximize Your Deductible in 2019

It’s the New Year, and you’re ready for a big change. If you have been thinking about weight-loss surgery, you may want to start the process early in 2019. The journey to weight-loss surgery can take time, and if you plan correctly, you can maximize your insurance deductible and get the most out of your health benefits.

“The journey to weight-loss surgery can take seven to eight months,” says Ronda Hart, APRN, Bariatric Nurse Practitioner at the St. Elizabeth Physicians Weight Management Center. “Eight months may seem like a long time, but most insurances have pre-operative dietary requirements, and some require a very strict timetable with no missed appointments.”

As an elective surgical procedure, weight-loss surgery is often a calculated decision. Almost all insurances have a deductible—what you pay before the insurance plan starts to pay. Depending on your coverage, your deductible can be as low as $500 or as high as $10,000. Insurance plans also have a maximum out-of-pocket medical expense—the maximum you will have to pay in one year including deductibles, coinsurance and copayments. If you can start and complete the weight-loss surgery process in the same year, you could save yourself some money and maximize your insurance benefit.

The Steps to Weight-Loss Surgery

The journey to surgery will vary for each patient. Having surgery at a center accredited by the American Society for Metabolic and Bariatric Surgery (ASMBS) will typically include the following required steps:

  • Completing a patient information session. This orientation session can be attended in person or completed in the comfort of your home through an online class.
  • A welcome appointment with a surgeon. You will meet with a bariatric surgeon to have an initial consultation to determine your medical eligibility for surgery.
  • Behavioral health testing and face-to-face evaluation. A mental health evaluation is routine before you begin your weight-loss journey. This preparation will help you identify strengths and weaknesses to help you be successful in the surgery process.
  • Pre-surgical diet phase. You will be required to complete a series of appointments with the nurse practitioners and dietitians in the weight-loss program to complete a medically supervised diet. You will learn ways to improve your health and promote weight loss through exercise and healthy behaviors.
  • Pre-operative testing. You will be required to complete pre-operative testing. Depending on your health issues, you may be required to have blood work, chest X-ray, ultrasound, sleep studies, electrocardiogram (EKG), pulmonary function test or other evaluation studies.
  • Attend a series of education classes. All accredited weight-loss surgery programs require you to attend a series of education classes. These classes may be conducted in a group setting.
  • Appointments for surgical preparedness. Prior to surgery, you will need to have an appointment with your surgeon to explain the benefits and risks of surgery. You will also be required to have an additional appointment with a dietitian and nurse practitioner to prepare you for surgery and recovery after surgery.

“The components to prepare for weight-loss surgery are the same for most patients, with the exception of pre-surgical diet, which we call diet trials at St. Elizabeth,” says Ronda. “The diet trial phase is dictated by insurance and can vary from three months to 12 months, with six months being the average.”

If your insurance requires a six-month pre-surgical diet phase, the time from orientation to surgery would take from January 1 to approximately August 5. After surgery, there are also a series of follow-up appointments to ensure your weight-loss success.

Ronda explains at St. Elizabeth Physicians Weight Management Center they work with you and your insurance provider to help you qualify for surgery, “Insurance benefits can be very confusing. Some insurance plans provide good coverage for surgery, others have limited coverage, and some exclude bariatric surgery entirely.”

If you are considering weight-loss surgery, call your insurance company to understand your coverage. Most hospitals have financial counselors to help you understand the cost of a procedure or test. Ronda says, “It can lessen the confusion if you take an active role in understanding the finances and program requirements.”

The earlier in 2019 you begin the process, the more likely you are to maximize your insurance benefits in 2019 and begin your journey to a healthy new you.

To learn more about weight-loss surgery at St. Elizabeth Physicians Weight Management Center, visit stedocs.com/weightmanagement, watch the online patient orientation or attend a live orientation. For more information call 859-212-4625 (GOAL).