Surgical Weight Management - Lahser Medical And Surgical Weight Loss Center

Lahser Medical And Surgical Weight Loss Center - Surgical Weight Management

Insurance Summary

Blue Care Network

Blue Care requires three years of medical documentation indicating some type of weight loss attempt. You will need to have your primary care physician send copies of your notes. You will need to have an authorization to see the surgeon. The visit for the medical evaluation is out of pocket as our physician does not participate. For the psychological evaluation and testing you will need referral authorization which may be through Value Options and may be your cost if not a covered benefit. You should call Blue Care Network for this number. Once the team feels you are a candidate for surgery, copies of the dictation and three years of documentation will be sent to Blue Care Network for authorization. This process can take 30 - 45 days. Your surgery will be scheduled once authorization is received.

Blue Choice

Blue Choice requires three years of medical documentation indicating some type of weight loss attempt. You will need to have your primary care physician send copies of your notes. For the psychological evaluation and testing you will need referral authorization which may be through Value Options and may be your cost if not a covered benefit. You should call Blue Care Network for this number. Once the team feels you are a candidate for surgery, copies of the dictation and three years of documentation will be sent to Blue Care Network for authorization. This process can take 30 - 45 days. Your surgery will be scheduled once authorization is received.

Blue Cross Blue Shield

Blue Cross Blue Shield requires that you have a BMI of 40 or above, you are over 18 years of age and that you have a medical, psychological and surgical evaluation. Once you have the evaluations with the Health Enrichment Center, your surgery will be scheduled as long as the entire team agrees that you are a candidate for surgery.

Blue Cross Blue Shield PPO

Blue Cross Blue Shield requires that you have a BMI of 40 or above, you are over 18 years of age and that you have a medical, psychological and surgical evaluation. There are a few employer groups with BCBS PPO that require prior authorization. They are General Motors, Federal Employees Program and Michigan Conference of Teamsters Welfare Fund. For these employer groups, once the dictation is complete, copies will be sent to the insurance for authorization. This process can take 30 - 45 days. Your surgery will be scheduled once authorization is received, as long as the entire team agrees that you are a candidate for surgery.

Care Choices

Care Choices requires documented attempts at medically supervised weight loss. You will need to have your primary care doctor send us this documentation. You will need to have an authorization to see the surgeons. The visit for the medical evaluation may be out of pocket if the physician does not participate. You will need to contact Care Choices to see if the psychological portion of the evaluation will be covered. If our Psychologist does not participate it will be out of pocket. If it is done outside of our facility, you must have the results of the test sent to the Health Enrichment Center, and you will still need to have a short visit with our psychologist that will be a charge to you. ***(Note that the MMPI-2 test must be no longer than 6 months old)*** Once our team feels you are a good candidate for surgery, we will request authorization from your insurance company, along with copies of the dictation and proper documentation showing medically managed weight loss attempts.

Commercial Carriers

You should check with your individual carrier to see what their requirements are. After the dictation for al the evaluations are complete, and the team feels that you are a candidate for surgery, copies will be sent to you insurance company, as prior authorization may be necessary before surgery.

Managed Care Medicaid

All Medicaid HMO's requires documented attempts at medically supervised weight loss. You will need to have your primary care doctor send us this documentation. You will need to have an authorization to see the all physicians and the surgeons. The visit for the medical evaluation may be out of pocket if our physician does not participate. You will need to contact your insurance to see if the psychological portion of the evaluation will be covered. If our Psychologist does not participate it will be out of pocket. If it is done outside of our facility, you must have the results of the test sent to the Health Enrichment Center, and you will still need to have a short visit with our psychologist that will be a charge to you. ***(Note that the MMPI-2 test must be no longer than 6 months old)*** Once our team feels you are a good candidate for surgery, we will request authorization from your insurance company, along with copies of the dictation and proper documentation showing medically managed weight loss attempts.

*** ALL REFERRALS NEEDED ARE YOUR RESPONSIBILTY ***

Medicaid

Medicaid requires three years documented attempts at medically supervised weight loss. You will need to have your primary care doctor send us this documentation, and give us any weight loss information you have gathered. The psychological portion of the evaluation will not be a covered benefit, as our Psychologist does not participate with Medicaid. This will be out of pocket. If it is done outside of our facility, you must have the results of the test sent to the Health Enrichment Center, and you will still need to have a short visit with our psychologist that will be a charge to you. ***(Note that the MMPI-2 test must be no longer than 6 months old)*** Once our team feels you are a good candidate for surgery, we will request authorization from Medicaid for surgery. This process can take anywhere from 1 to 12 months.

Medicare

Medicare requires five years worth of medical documentation for the surgery to be performed. You will need to have your primary care doctor send us this documentation, and give us any weight loss information you have gathered. You should contact all previous doctors to retrieve any information that could be useful. After you have had you medical, psychological and surgical evaluation and the team feels that you are a good candidate for surgery, we will schedule a surgical date.

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