Both Dr. Brewer and Dr. Hodges are board certified surgeons who are in-network providers with most insurance companies. Unfortunately, they are not Medicare or Medicaid providers, but can work with patients with this type of coverage on an individual basis. Prior to your initial consultation, your insurance will be verified to determine your bariatric coverage. During your visit, patients will have the opportunity to speak with pre-determination / insurance specialists to help guide you through the insurance approval process.
Insurance Process / Road to Surgery
At New You Bariatric Center, we are committed to working with you and your insurance company throughout the entire approval process. We have insurance and pre-determination specialists that work with each of our patients on an individual basis to navigate the insurance approval process.
The following steps are what we see for a typical patient. The time for approval and thus surgery can be different for patients depending on your insurance requirements, prior doctor/nutrition visits and past surgical history. We work with each patient, on a case by case basis, to help navigate and expedite your approval. We offer comprehensive coordination of care for our patients. We will help with all of the scheduling of your necessary consultations. Each patient will have a Pre-D/insurance specialist to guide them throughout the insurance process.
Step 1: Insurance Verification
- Ideally, we will get your insurance information PRIOR to your first appointment. This allow us to contact your insurance company to verify your benefits, define your surgery requirements, and determine your co-pay / out-of-pocket expenses.
- Verification typically takes 24 hours.
Step 2: Initial Consultation
- During your first appointment, we will discuss the surgical options that are best for you.
- After meeting with the surgeon, you will have the opportunity to meet with our insurance / pre-determination specialist to go over your benefits and start the insurance / predetermination process.
- Patients must be receive an authorization for surgery from their insurance company in order to proceed with surgery.
Insurance approvals CAN be transferred between providers. If you ALREADY have an insurance approval, we can transfer the approval to one of our in-network providers.
Step 3: Completing Pre-Determination / Getting an Approval
Getting an approval is the most time consuming portion of the process. We have a pre-determination department that can handle all questions and guide you to through the process. Patients will be assigned a pre-determination specialist at their initial consultation.
Most insurance companies have specific requirements in order for a patient to be approved for surgery.
The approval process and time to surgery for patients, without a required diet, typically takes 4-6 weeks. Depending on your requirements, this process can take less time.
If your insurance was verified prior to your first appointment, we will have all of these requirements to discuss with you at your initial consultation.
New You Bariatric Center and insurance companies typically require, BUT ARE NOT LIMITED TO, the following:
- BMI of 35 or more
- Letter of Medical Necessity
- Nutritional Consultation
- Psychological Evaluation
- Sleep Study
- Lab work
Some insurance companies have a diet program or waiting period. This can be three months up to one year. Typically, these require a patient to meet with a nutritionist or multi-disciplinary team for three to six CONSECUTIVE months within the last 24 months.
We can coordinate these diet visits with you.
Occasionally, patients have already undergone nutritional counseling for diabetes, weight loss medications, etc. We will need to get all documentation and will discuss with the insurance if these visits meet the criteria for insurance approval.
We will get you the link for the nutritionist as well as an email for the pts to use for questions.
Most patients will require an EGD prior to surgery. This is an outpatient procedure, covered by insurance that allows the surgeon to evaluate your esophagus, stomach and first portion of your small bowel prior to surgery.
An EGD is especially helpful for revision patients because it:
- Provides the surgeons with valuable information about your anatomy to help with surgical planning.
- Provides evidence and information to insurance companies to help facilitate an approval
Step 4: Approval
- Once you have completed your insurance requirements, your information will be forwarded to your insurance company.
- Insurance companies typically have 15 days to complete the approval process.
- Approvals typically last 90 days, and can be renewed.
- If you have an approval with another facility / surgeon, we can transfer the approval to either Dr. Hodges or Dr. Brewer. This process can take as little as 24 hours.
- If you have been denied, we will work with you and your insurance provider for an appeal. We can submit appeals for patients if they received a denial with us or with another provider.
Step 5: Stress Test
Prior to your surgery, all patient will undergo a stress test. If you have had a previous stress test / angiogram within the last 12 months and have not had any cardiac issues, then you may not need additional testing.
Step 6: Schedule Surgery
- Once you have received an insurance approval, we will schedule you for your desired surgery.
- If you are a cash paying patient, typically, you will still need an EGD, stress test, psychological evaluation and nutritional evaluation to proceed with surgery.
Contact one of our specialist today for more information at (214) 838-7171 or contact page. We can have insurance verification in 24 hours. Start your weight loss journey today!
As a patient interested in bariatric surgery, do you:
- Have an exclusion, or not have bariatric coverage with your insurance?
- Not have insurance coverage?
- Have high deductibles / surgery co-pays?
If you answered yes to any of these questions, then healthcare financing may be an option to your New You! Whether you need help covering the entire cost of surgery, or simply need assistance meeting your surgery deductible and out-of-pocket expense, New You Bariatric Center is pleased to offer financing with Prosper Healthcare Lending. Prosper Healthcare Lending is the premier financing company in the healthcare industry. With over $5 Billion borrowed and over 250,000 people empowered, this is a name and a program you can trust.
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- Gastric Bypass
- Sleeve Gastrectomy
- Duodenal Switch
- Revision Bariatric Surgery
- Intragastric Balloon
- Post-Surgery Appointments
- Bariatric Vitamins / Nutrition / Medications
- Other related treatments and procedures
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- Immediate decisions without affecting your credit!
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