Dealing with your health insurance provider can be daunting and overwhelming. We have an experienced team of Patient Advocates who will guide you each step of the way.
1) Seminar Attendance
Attending a seminar provides you with additional information about your surgical weight loss options and an opportunity to learn about the benefits and risks of surgery. You can attend an educational seminar online or call the St. Alexius NewStart office at 1-800-245-1431 for information regarding seminar dates, locations and registration.
2) Patient History Forms
You will need to complete a set of diet and medical history forms for your surgeon to review. You can download the forms from our website by clicking here. We can also mail these forms to your home, or they may also be picked up at a St. Alexius NewStart seminar or office.
3) Initial Consultation
After completing an educational seminar and completing your paperwork, you will be scheduled for a consultation with the surgeon of your choice. At this appointment you will meet with your surgeon, a patient advocate and have a nutrition consultation with a Registered Dietitian.
4) Psychological Evaluation
You will be required to participate in a routine evaluation performed by a licensed psychologist or psychiatrist. We can provide you with resources if you haven’t already chosen your professional. We can also provide guidelines to the doctor of your choice to ensure we receive all necessary information.
5) Medical Clearance Letter
You will be required to obtain a letter of medical clearance from your primary care physician, as well as a recent TSH level (thyroid blood test). This letter should include your health history, any co-morbidities for which you are being treated, any previous attempts at weight loss, and your doctor’s opinion as to your medical stability for bariatric surgery. Your doctor can call the St. Alexius NewStart office if they have any questions regarding this letter.
6) Additional Information
Your surgeon or insurance provider may request other information or documents in order to review your case. We will review all of these additional requirements with you, and will help you in obtaining them.
7) Insurance Letter
We will send a letter of medical necessity along with your program requirements to your insurance company; however, the approval can take four to eight weeks, so please be patient! Your insurance company will review the information and determine if there is medical necessity for bariatric surgery, and whether this procedure is a covered benefit under your health plan. We will check the status of your review on a weekly basis, but you are welcome to contact your insurance company directly for an update.
8) Insurance Billing
We will obtain insurance pre-certification and benefit coverage for surgery, pre-operative testing and your hospital stay. The office will file claims to your primary and secondary insurance carriers as a courtesy. Co-Payments and/or deductibles are expected at the time you sign in at the office for services to be rendered. Any deductibles or co-insurance fees that have not been met must be paid to the hospital prior to surgery. Your St. Alexius NewStart surgeon will bill your insurance company for the surgeon fee and assistant surgeon’s fees. There may be additional charges billed by other providers, including services related to anesthesia, consultations, and/or interpretation of pre-or post-operative tests. Your insurance benefits will be reviewed with you prior to surgery. Please, make sure you understand your insurance coverage and financial responsibility prior to surgery.
1) Pre-Surgery Education and Testing
We realize you’re busy. We’ll make sure your pre-operative testing day and dietary education, provided by a Registered Dietitian, are held the same day and go as quickly and smoothly as possible.
2) Surgical Consultation
Once you’ve completed pre-operative testing and all your results are received, you will be scheduled for a surgical consultation with your surgeon. This surgical consultation generally cannot be scheduled the same day as your pre-operative testing and dietary education.
The St. Alexius NewStart program includes post-operative follow-up care with our highly qualified, experienced, bariatric Registered Dietitians at no extra charge. There may be additional charges to see the surgeon in the office after the first 90 days. St. Alexius NewStart staff would be happy to review these with you prior to your appointment.
Follow-up appointments with your surgeon and Registered Dietitian are crucial to successful outcomes. You will need to come in one week, one month, three months, six months, one year and annually thereafter. After each appointment, you can schedule your next one.