Procedures covered by Insurance companies and Medicare
The Gastric Sleeve and the Laparoscopic Gastric Bypass procedure are covered by Medicare, Medicaid and many Insurance companies.
The best way to determine if your insurance policy covers obesity (or "bariatric") surgery, is to call them and ask. We can do that for you or you can do it yourself.
If you want us to do it, please call us at (956) 631-8155. We will need your insurance information, your date of birth and your name as it appears on your insurance card. We will call your insurance provider and we will call you back as soon as we have an answer. Due to the large number of patients that require this service, it usually takes us one week before we can get that information for you.
Each insurance plan has different requirements to consider you as a candidate for weight loss surgery. All of them require your BMI to be higher than 35. If your BMI is between 35-40, most plans will request proof that you to suffer from one medical condition related to being severely obese. We offer free BMI calculation at our office with our dedicated professional scales.
Another option for insurance verification is to send us a picture of the front of your insurance card via Facebook inbox. Please include your date of birth and a contact number where we can call you back.
Finally, we hold biweekly free seminars at Rio Grande Regional Hospital and Mission Regional Medical Center. My staff will be there and will be happy to collect your insurance information at that time. We can also help you calculate your BMI.
First Office Visit
Once we have verified and confirmed that your insurance plan covers obesity surgery, and that you meet their criteria for surgery, you will visit Dr. Mario del Pino or one of his assistants for an evaluation.
During that first evaluation, Dr. del Pino will help you decide which is the type of procedure that suits you best. He will also determine a work up plan that will help you get insurance approval for the surgery.
Work up Plan
In the US, it is mandatory to obtain medical, psychology and dietary clearances before surgery. These evaluations cannot be more than three months old at the time of surgery and cannot be done by us. We will help you set up appointments and schedule tests.
Medical Weight Loss Treatment Documentation
In addition to the clearances mentioned above, most insurance plans require the patient to provide documentation that they have received medical weight loss treatment for several months and that they have failed to lose weight with them. This documentation can be provided by a physician, nurse practitioner, physician assistant or a dietician. We are not allowed to provide that.
This information must be collected and documented monthly. Some insurances require 3,4, 6 or sometimes even 12 months of consecutive monthly visits. If you don’t provide it, the surgery will not be approved. Medical Weight Loss Treatment documentation from Mexico is valid, but it must be in English.
We can provide you with samples of medical weight loss treatment documentation.
Letter of Medical Necessity
A Letter of Medical Necessity and weight-loss history are necessary to obtain prior authorization for obesity surgery. A Letter of Medical Necessity states why significant weight loss is medically necessary for a patient and usually includes the following information:
- Patients weight (which should be 100 pounds or more above ideal weight or a BMI more than 40 or at least 35 with associated medical problems to qualify
- List of medical problems associated with obesity such as type 2 diabetes, sleep apnea, hypertension, etc.)
- Number of years the patient has been overweight
- Number and type of failed weight-loss programs attempted in the past
If you create a document or packet listing all your weight-loss attempts (self-controlled or medically supervised) and their results, you can substantially increase your chances of getting insurance coverage for weight loss surgery. You should include any commercial diets or medical records of your weight-loss efforts.
Additional evaluations or tests
Sometimes, depending on your overall health condition, additional medical evaluations or clearances may be required like: cardiology, pulmonary, endocrinology, etc.
Also, sometimes additional testing is required:
- Abdominal ultrasound
- Upper endoscopy
- Lower extremity venous Doppler
If you do not have insurance or your insurance does not cover weight loss surgery
When insurance reimbursement is not available, you may consider our cash program or patient financing. We work with the Care Credit System (www.carecredit .com). Please ask us about available patient cash and financing programs during the bariatric seminar or your office visit.
Please click the Care Credit link below to fill out an application form and find out right away if you qualify for credit for weight loss surgery.
» Care Credit System