Northwest Houston Surgical Association

Insurance Issues

Houston weight loss surgery and insurance FAQWhen you meet with any of the NHSA surgeons for a consultation, they will carefully consider what will help you attain the best possible outcome for you and your lifestyle. Insurance issues dealing with weight loss surgery in Houston and Cypress will be addressed. They will educate you until they are convinced that you understand the risks and benefits of the weight loss option you choose. Request a consultation online or call our office at 713-426-2400 for more information about how you can take the steps toward improving your life.

 

WHY DOES IT TAKE SO LONG TO GET INSURANCE APPROVAL?

After your telephone interview consultation is completed, it usually takes your doctor 1-2 days to send a letter to your insurance carrier to start the approval process. The time it takes to get an answer can vary from about 3-4 weeks or longer if you are not persistent in your follow-up. Most treatment centers have insurance analysts who follow up regularly on approval requests. It may be helpful for you to call the claims service of your insurance company about a week after your letter is submitted and ask about the status of your request.

  • dr-fadner-img
    Meet Our Doctors

    Dr. Fadner

    Dr. Fadner is fellowship trained in Advanced Minimally Invasive Surgery and Bariatric Surgery and offers a wide range of general surgery operations to his patients.

  • Dr. Levia
    Meet Our Doctors

    Dr. Leiva

    A certified General Surgeon at the forefront of single incision and robotic general surgery. Dr. Leiva also has a special interest in primary and revision, advanced laparoscopic.






  • Dr. Amir
    Meet Our Doctors

    Dr. Amr

    As a highly skilled and fellowship trained weight loss surgeon, Dr. Amr is skilled in laparoscopic foregut surgery and bariatric (weight loss) surgery.






  • Dr. Ayyar
    Meet Our Doctors

    Dr. Ayyar

    Dr. Ayyar has pioneered minimally invasive surgery in the West and Northwest Houston area. His expertise in minimally invasive and endocrine surgery allow him to perform parathyroid operations.






HOW CAN THEY DENY INSURANCE PAYMENT FOR A LIFE-THREATENING DISEASE?

Payment may be denied because there may be a specific exclusion in your policy for obesity surgery or “treatment of obesity.” Such an exclusion can often be appealed when the surgical treatment is recommended by your surgeon or referring physician as the best therapy to relieve life-threatening, obesity-related health conditions, which usually are covered. Insurance coverage for weight loss patients in Houston or Cypress may also be denied for lack of “medical necessity.” A therapy is deemed to be medically necessary when it is needed to treat a serious or life-threatening condition. In the case of morbid obesity, alternative treatments-such as dieting, exercise, behavior modification, and some medications – are considered to be available. Medical necessity denials usually hinge on the insurance company’s request for some form of documentation, such as 1-5 years of physician-supervised dieting or a psychiatric evaluation, illustrating that you have tried unsuccessfully to lose weight by other methods.

WHAT CAN I DO TO HELP THE PROCESS?

Gather all the information (diet records, medical records, medical tests) your insurance company may require. This reduces the likelihood of a denial for failure to provide “necessary” information. Letters from your personal physician and consultants attesting to the “medical necessity” of treatment are particularly valuable. When several physicians report the same findings, it may confirm a medical necessity for surgery. When the letter is submitted, call your carrier regularly to ask about the status of your request. Your employer or human relations/personnel office may also be able to help you work through unreasonable delays.

If you’re ready to improve your life, request a consultation online or call our office at 713-426-2400 for more information.

Obalon Balloon System Surgery

The Obalon Balloon System helps facilitate weight loss by taking up space in your stomach so you eat less.






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Gastric Band

As one of the more popular procedures, LAP-BAND® surgery gives patients the ability to control their weight by allowing them to feel fuller, sooner.






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Gastric Bypass

Gastric bypass is successful at helping patients achieve and maintain a healthier weight by using sectioning and malabsorptive techniques.






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Sleeve Gastrectomy

A sleeve gastrectomy procedure involves removing about 85% of the stomach and reshaping the remaining portion into a tube or sleeve.






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Duodenal Switch

The Biliopancreatic Diversion with Duodenal Switch (BPD/DS) is a popular procedure for small stomachs combining a lower form of restriction and a high level of malabsorption.






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