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Insurance coverage varies for weight loss surgery procedures. It is crucial that you call your insurance provider to determine if your policy covers surgical weight loss. As an integral part of our team, a financial counselor can answer questions and give you guidance when working with your insurance company to acquire approval. It is a team effort between you and our financial counselor to ensure we do everything possible to gain an approval for surgical weight loss procedures such as laparoscopic gastric bypass surgery.

We understand the importance of surgical weight loss procedures and will work with you every step of the way. Should your insurance deny coverage, we will actively work with you to appeal the decision.

CCF has partnered with Bank of America to offer you an additional source for funds to help pay for elective surgical procedures or personal needs.

Click here to learn about Bank of America financing.

Cleveland Clinic accepts all major insurance carriers, including Medicare and Medicaid.

To contact our financial counselors about surgical weight loss procedures, call Debra Cash at 216-445-1745/800-223-2273, ext 51745 or by email at cashd@ccf.org or Tammy Hall at 216-636-0795/800-223-2273, ext 60795 or by email at hallt3@ccf.org.

Gaining Approval
Most insurance companies will require extensive documentation regarding your attempts to lose weight in the past as they determine whether or not to finance your surgical weight loss procedure. To be prepared, we ask that you gather the following information:

1. Medical documentation of a five-year weight history
2. Any actual documentation of diet drugs and medically supervised diets prescribed
3. Any commercial diet program records (Weight Watchers, Jenny Craig, etc.)
4. Any exercise program records (YMCA/YWCA, gym membership, etc.).

You will need to begin gathering these records NOW so that these are available when we communicate with your insurance company. It is NOT enough for you to simply list these items on the Health Questionnaire. The insurance company will require official documentation of attempts at weight loss.

If you have a weight history and weight treatment history at Cleveland Clinic, we will gather that weight information and the weight loss drugs prescribed by Clinic doctors from your Cleveland Clinic medical record. For weight history outside Cleveland Clinic or its satellite offices, you will need to contact the doctor who weighed you and/or prescribed weight loss drugs for a copy of that documentation. A summary letter of dates, weights, medications prescribed and supervised diets from that doctor is acceptable. You may need to contact commercial diet program offices and exercise facilities for records if you do not have these.

Acquiring Approval
Once your test results, consults, weight history, diet and exercise program documentation and other records have been received and reviewed by our office, we will submit a letter of recommendation to your insurance carrier requesting approval for the weight loss surgery procedure. Your medical records are forwarded to your insurance company with this letter. The insurance company will let us know if there is any additional information they will need to make the decision to approve or deny your weight loss surgery.

Some insurance companies will make the decision about your weight loss surgery within a few weeks. Some insurance carriers take several weeks or months to return a decision. We will contact you when we have heard from your insurance company. You may contact your insurance company to check on the status of your insurance approval.

If your insurance company denies the request for coverage of your weight loss surgery procedure, our financial counselor will discuss appeals and self-pay options with you.

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Insurance List

The insurance companies referenced are only a summarization of those accepted by Cleveland Clinic. This does not guarantee that you have bariatric coverage nor that you will be accepted into the bariatric program. In addition, we may accept other carriers not specifically identified. Please contact us directly to clarify any concerns.
 
Insurance Carrier Contact Phone Number Medically Supervised Diet Diet History Notes
Medical Mutual of Ohio 800-362-1279 3 MONTHS 2 YEARS  
***GM Division 800-533-4755 6 MONTHS 2 YEARS  
Aetna 888-632-3862 6 MONTHS- 3 CONSECUTIVE NONE  
Cigna 800-244-6224 3 MONTHS NONE  
Antares / CCHS
(EHP ID #'s)
800-451-7929 NONE 1 YEAR Patient needs to be under healthplan for 2 years prior
to being eligible for surgery- also has to have BMI of
40 or greater for 1 year- pay surgical copay of $2750
Antares / CCHS
( EMH ID #'s)
800-451-7929 NONE 1 YEAR Does not follow the 2 yr requirement - does not have
copay req either- needs BMI of at least 40 for 1 year
United Healthcare 877-842-3210 6 MONTHS- or 2- 3 MONTH Programs 5 YEARS  
Tricare 877-874-2273 PRIME PLANS- 6 MONTHS    
Anthem BCBS 800-676-2583 NONE 5 YEARS  
BCBS Federal 800-451-7602 NONE NONE  
BCBS GM Plans 800-345-4907 6 MONTHS    
BCBS of Michigan 800-344-8525 6 MONTHS UNLESS BMI IS > OR = TO 50    
Highmark BCBS 800-547-3627 6 MONTHS    
Horizon BCBS-
New Jersey
800-624-1110 6 MONTHS NONE  
BCBS of Illinois 800-541-2767 3 MONTHS NONE  
BCBS of Minnesota 800-531-6676 6 MONTHS 2 YEARS  
BCBS of South Carolina 800-676-2583 NO    
Empire BCBS 800-676-2583 NO NONE  
BCBS of Virginia 800-533-1120 NO NONE  
Excellus BCBS-Rochester, NY 800-676-2583 6 MONTHS 5 YEARS No substance abuse for 6 months prior to surgery;
5% weight reduction from start of program till surgery request
BCBS of
Western New York
800-676-2583 6 MONTHS    
BCBS of Florida 800-676-2583 6 MONTHS    
BCBS of Massachusettes 800-443-6657      
BCBS of Tennessee 800-676-2583 NO 5 YEARS  
Carefirst BCBS- Maryland 800-676-2583 6 MONTHS    
BCBS of North Carolina 800-676-2583 NONE 2 YEARS  
BCBS of Alabama 800-676-2583 6 MONTHS 3 YEARS Must quit smoking at least 8 weeks prior to surgery
BCBS of Texas 877-235-9258 3 MONTHS 5 YEARS  
Wellpoint 800-676-2583 NONE NONE  
BCBS of Georgia 800-676-2583 NONE NONE  
Independence BC 800-676-2583 NONE NONE  
Arkansas BCBS 800-676-2583 6 MONTHS NONE  
Mountain State BCBS 800-676-2583 6 MONTHS NONE  
Meritain Health   6 MONTHS or 2- 3 MONTH DIETS 5 YEARS Cardiac Clearance
Chesterfield Resources   6 MONTHS 3 YEARS  
Business Administrators & Consultants (MMO) 614-863-8780 or 800-521-8654 6 MONTHS    
Employee Benefit Management (MMO) 877-304-0761 2 Yr Program- ACMS 800-831-6677    
Benefit Services (MMO) 800-367-3762 6 MONTHS    
Wells Fargo 800-428-1291      
Central States 800-323-5000      
Ohio Medicaid 800-686-1516 6 MONTHS    
***Permedion
(OH Medicaid)
800-772-2179      
Caresource 800-488-0134 9 MONTHS    
Wellcare 800-951-7719 6 MONTHS    
SummaCare 330-996-8400     Needs referral
Humana 866-486-5295      
Klais and Company 330-867-8443      
Kaiser 216-623-8765     Needs referral
NALC 888-636-6252 6 MONTHS    
Paramount 800-462-3589      
ChampVa 800-733-8387      
Univera Healthcare 800-628-8451      
Aultra Administrators 800-325-8424      
Aultcare 330-363-6360      
Forum Health 330-726-5806      
Principle Life Insurance (MMO) 800-533-5044 6 MONTHS     
Advantra Freedom 866-386-2330      
Ministry of Health       Prior Approval Application for Full Payment of Insured Out of Country Health Services must be completed by your primary care physician per Ontario Ministry of Health for your care to be paid for.


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Now that you have read about your insurance and financing options, click here to get started on your Pathway to Surgery.
 
 
            
                         
                         
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